儿童血栓弹力图参考区间建立及与常规凝血项目的比较  

Establishment of thrombelastography reference interval in children and its comparison with traditional coagulation tests

作　　者：夏丽波[1] 简翠[1] 张碧玉[1] 王斌[1] 孙自镛[1] 唐宁[1] XIA Libo;JIAN Cui;ZHANG Biyu;WANG Bin;SUN Ziyong;TANG Ning(Department of Clinical Laboratory,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,湖北武汉430000

出　　处：《检验医学》2017年第2期81-85,共5页Laboratory Medicine

基　　金：国家自然科学基金青年基金项目(81200353)

摘　　要：目的建立儿童快速血栓弹力图试验(r TEG)及高岭土血栓弹力图试验(CK-TEG)的参考区间,评价其与常规凝血项目的相关性,并了解CK-TEG在血友病患儿中的应用价值。方法选取242例择期手术儿童、40名健康成人及42例血友病患儿,分别检测其CK-TEG、r TEG及常规凝血项目,儿童按<1个月、1个月~1岁、2~5岁、6~10岁及11~16岁分为4个年龄段。结果 r TEG及CK-TEG参数提示各年龄段儿童较成人偏高凝:Angle、MA、G显著增高(P<0.05),K显著缩短(P<0.05),并与血小板(PLT)、纤维蛋白原(Fib)水平明显相关(P<0.05);ACT、R、LY30分别与凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(DD)明显相关(P<0.05)。血友病患儿CK-TEG各参数均明显异常,存在因子抑制物的患儿的R值明显高于无因子抑制物患儿(P<0.05)。结论血栓弹力图各参数可反映PLT水平、内外源凝血活性、Fib功能及纤溶活性,并有助于筛选存在因子抑制物的血友病患儿。Objective To establish the reference intervals of rapid thrombelastography(rTEG) and Kaolin thrombelastography(CK-TEG) in children,and to evaluate their correlations with traditional coagulation tests and the role of CK-TEG among children with hemophilia. Methods A total of 242 children undergoing elective surgery,40 healthy adults and 42 children with hemophilia were enrolled,and rTEG,CK-TEG and traditional coagulation tests were performed. All children were classified into <1 month old,1 month old-1 year old,2-5 years old,6-10 years old and 11-16 years old groups. Results Compared with adults,children exhibited more hypercoagulation according to rTEG and CK-TEG parameters(high Angle,MA and G and short K)(P<0.05),and these 4 parameters were also correlated with platelet(PLT) and fibrinogen(Fib)(P<0.05). In addition,ACT,R and LY30 were correlated with prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer(DD)(P<0.05). All CK-TEG parameters were abnormal for children with hemophilia,and R with factor inhibitor was higher than that without factor inhibitor(P<0.05). Conclusions The parameters of thrombelastography could reflect the levels of PLT,Fib,coagulation activity and fibrinolysis,and it is helpful to screen coagulation factor inhibitor for children with hemophilia.

关 键 词：快速血栓弹力图 高岭土血栓弹力图 儿童 凝血功能 参考区间 

分 类 号：R446.1[医药卫生—诊断学]