152例肝硬化患者血栓弹力图检测的临床意义  

The clinical significance of thromboelastography detection in 152 cases of patients with liver cirrhosis

作　　者：杜小龙[1] 何松[1] 左国庆[2] 

机构地区：[1]重庆医科大学附属第二医院消化内科,400010 [2]重庆市中医院消化内科,400021

出　　处：《重庆医学》2016年第28期3931-3933,3936,共4页Chongqing medicine

摘　　要：目的分析在肝硬化患者中血栓弹力图(TEG)检测的临床意义。方法选取2014年6月至2015年11月入住重庆医科大学第二附属医院消化内科的肝硬化患者152例,其中有36例出现了消化道出血,同时选取无肝胆系统疾病、无血液系统疾病、无肿瘤病史、未服用抗凝药物史的健康体检者50例作为对照组,根据患者是否合并消化道出血,将肝硬化组分为出血组和未出血组。所有研究对象均于清晨空腹抽取外周静脉血2、3、3mL分别行常规凝血试验(PT、APTT、INR、FIB)及TEG(R值、K值、α角、MA值、CI值)。另通过ROC曲线,比较TEG各参数、常规凝血试验各指标及血小板(PLT)计数评估肝硬化患者消化道出血风险的特异性及灵敏度。结果肝硬化组随着肝功能Child-Pugh分级的增加,R值、K值逐渐增大,α角、MA值逐渐变小;与未出血组相比,出血组的α角、MA值、CI值、PLT计数、FIB差异均有统计学意义(P<0.05),其余指标差异无统计学意义(P>0.05);通过ROC曲线下面积比较发现,α角、MA值、PLT计数、FIB曲线下的面积均大于0.5;其中,α角ROC曲线下的面积最大(>0.7)。结论 TEG可用于反映肝硬化患者的凝血功能,对肝硬化患者消化道出血风险有一定的预测价值,但预测价值有限。Objective To analyze the clinical significance of thromboelastography detection in patients with liver cirrhosls. Methods A total of 152 cases of liver cirrhosis were selected from June 2014 to November 2015 in the Second Affiliated Hospital of Chongqing Medical University, 36 cases of them appeared gastrointestinal hemorrhage, 50 cases of health persons with no hepatobiliary diseases,no blood system diseases, no history of cancer, and no history of anticoagulants taking were selected as control group. All the research subjects were divided into liver cirrhosis group and control group,the liver cirrhosis group was separated into hemorrhage group and non hemorrhage group according to whether the cases with gastrointestinal hemorrhage. All of the research subieets were sampled the peripheral venous blood 2,3,3 mL in the fasting state in the morning,then detected the routine blood, the routine coagulation tests （PT. APTT. INR. FIB） and thromboelastography（R value, K value, a-angle, MA value, CI value） and the routine blood respectively. The data were analyzed between the liver group and control group, the hemorrhage group and non hemorrhage group;detecting whether these indexes had significant statistical differences. And the ROC curve was used to assess the risk of cirrhosis gastrointestirial hemorrhage in patients with cover corrhosis specificity and sensitivity by comparising the thromboelastography parameters,the routine coagulation tests indexes and the PL＇I＂ counts. Results With the increase of Child-Pugh classification of liver function, the R value and K value of TEG parameters gradually increased, the a-angle and MA value gradually became smaller. Compared with the non hemorrhage group,the MA value, CI value, PLT counts, and FIB in the hemorrhage group were significantly different（P〈0.05）, and other indicators had no statistical difference（P〉0.05）. By comparing the areas under the ROC curve, the area under the a-angle, MA value, PLT counts, and FIB were more than 0.5;among them, the

关 键 词：血栓弹力描述术 凝血试验 肝硬化 胃肠出血 

分 类 号：R575.2[医药卫生—消化系统]