血栓弹力图评价慢加急性肝衰竭患者的凝血功能及预后研究  

Value of thromboelastography in evaluating coagulation function and prognosis in patients with acute-on- chronic liver failure

作　　者：曾艳丽[1] 高飞[1] 魏君峰[1] 侯环荣[1] 靳秀[1] 丁岗强[1] 殷辉[1] 尚佳[1] 康谊[1] 

机构地区：[1]郑州大学人民医院(河南省人民医院)感染科,450003

出　　处：《中华肝脏病杂志》2017年第1期32-37,共6页Chinese Journal of Hepatology

基　　金：河南省科技厅基础与前沿技术研究项目（142300410372、142102310127）;河南省医学科技攻关项目（201301009、201303120）;国家重点临床专科项目

摘　　要：目的通过血栓弹力图（TEG）检测慢加急性肝衰竭（ACLF）患者的凝血功能，全面动态地评估患者的出、凝血状态。方法收集ACLF患者资料，用TEG检测ACLF患者全血凝血动力学，同时检测常规生物化学指标，并评估并发症情况。计量资料用t检验，分类变量采用石。检验，相关性分析采用Pearson相关系数分析，P〈0．05为差异有统计学意义。结果共纳入60例患者资料，纳入患者平均（47．20±16．20）岁，男性39例，女性21例。TEG检测结果显示，患者血栓动力学正常。但TEG指标与凝血功能，全身炎症反应综合征指标、实验室指标及患者预后都存在相关性，R值延长患者并发感染（6．23±2．91和4．74±1．12，P=0．009）、肝肾综合征（5．64±2．54和3．21±1．43，P〈0．01）或出血（6．71±3．51和4．80±1．63，P=0．01）风险增加，而K值缩短（0．72±1．36和1．64±1．43，P=0．02），α-角升高（63．33°±10．02°和56．62°±12．13°，P=0．03），血栓最大幅度延长（56．83±11．07和50．40±10．81，P=0．03）的患者发生肝性脑病的风险增高。结论ACLF患者凝血功能低下，TEG真实地反应了这种低水平的“再平衡”状态。TEG指标的异常，预示ACLF患者出现肝衰竭并发症的风险增加，间接提示患者预后l青况。Objective To investigate the coagulation fimction in patients with acute-on-chronic liver failure （ACLF） patients using thromboelastography （TEG）, and to comprehensively and dynamically evaluate patients＇ bleeding and coagulation status. Methods The clinical data of ACLF patients were collected, and TEG was used to evaluate whole blood clotting kinetics in these patients. Routine biochemical parameters were measured, and complications were evaluated. The t-test was used for comparison of continuous data, the chi- square test was used for comparison of categorical data, and the Pearson correlation coefficient was used for correlation analysis. P 〈 0.05 was considered statistically significant. Results A total of 60 patients （39 male and 21 female patients） were enrolled, with a mean age of 47.20±16.20 years. The TEG results showed that all patients had normal thrombokinetics, but TEG parameters were correlated with coagulation fimction, markers of systemic inflammatory response syndrome, laboratory markers, and prognosis. The patients with a higher R value had higher risks of infection （6.23±2.91 vs 4.74±1.12,P= 0.009）, hepatorenal syndrome （5.64±2.54 vs 3.21±1.43 P 〈 0.01）, and bleeding （6.71±3.51 vs 4.80±1.63, P = 0.01）, and the patients with a lower K value （0.72±1.36 vs 1.64±1.43, P = 0.02）, an increased α-angle （63.33°±10.02° vs 56.62°±12.13°, P = 0.03）, and an increased MA （56.83±11.07 vs 50.40±10.81, P = 0.03） had increased risks of hepatic encephalopathy. Conclusion ACLF patients have low coagulation function, and TEG truly reflects the ＂rebalance＂ status of this low level. Abnormal TEG parameters suggest increased risk of complications in these patients, indicating a poor prognosis.

关 键 词：慢加急性肝衰竭 血栓弹力图 凝血障碍 

分 类 号：R575.3[医药卫生—消化系统]