不同阶段肝病患者血栓弹力图与常规凝血检测的一致性研究  

Consistency of thromboelastograph and routine coagulation testing in patients at different stages of liver disease

作　　者：赵青平[1] 陈昱昊 林芳[3] 王淑英 张杨丽 吕晓娜 刘佳[2] 王璐瑶 ZHAO Qing-ping;CHEN Yu-hao;LIN Fang;WANG Shu-ying;ZHANG Yang-li;LüXiao-na;LIU Jia;WANG Lu-yao(Clinical Laboratory,Affiliated Hospital of the Air Force Institute of Aviation Medicine,Beijing 100089,China;Deparment of Blood Transfusion,302 Military Hospital of China,Beijing 100039,China)

机构地区：[1]空军航空医学研究所附属医院检验科,北京100089 [2]解放军第三〇二医院输血科,北京100039 [3]解放军第三〇二医院重症医学中心,北京100039 [4]北京大学国际医院输血科,102200

出　　处：《传染病信息》2018年第2期157-160,共4页Infectious Disease Information

基　　金：首都临床特色应用研究(Z141107002514107)

摘　　要：目的对不同阶段肝病患者的血栓弹力图(thrombelastograph,TEG)参数R值和常规凝血功能指标PT和APTT进行对比研究。方法将2016年2月—2017年1月解放军第三〇二医院住院患者232例作为研究对象,其中慢性肝炎患者41例,肝硬化代偿期患者69例,肝硬化失代偿期患者79例,慢性肝衰竭患者43例。检测上述各类患者TEG参数R值和常规凝血指标PT、APTT,并对2种检测方法的检测结果进行对比研究。结果慢性肝炎患者R值与PT、APTT进行一致性分析后,kappa值分别为-0.135(P>0.05)、0.105(P>0.05),一致率分别为34.15%和60.98%。肝硬化代偿期患者R值与PT、APTT一致性分析后,kappa值分别为0.175(P<0.05)、0.038(P>0.05),一致率均为60.90%。肝硬化失代偿期患者R值与PT、APTT一致性分析后,kappa值分别为0.023(P>0.05)、0.038(P>0.05),一致率分别为43.04%和49.37%。慢性肝衰竭患者R值与PT、APTT一致性分析,kappa值均为-0.049(P>0.05),一致率均为13.95%。结论因TEG是从不同角度检测凝血功能,TEG检测结果可为评估不同阶段肝病患者凝血因子状态提供更加全面的依据。Objective To study the consistency of thromboelastograph(TEG)parameters and routine coagulation parameters(PT,APTT)in patients at different stages of liver disease.Methods A total of 232 inpatients at different stages of liver disease were enrolled from the 302 Military Hospital of China from February 2016 to January 2017,including 41 patients with chronic hepatitis,69 patients with compensatory cirrhosis,79 patients with decompensated cirrhosis and 43 patients with chronic liver failure.TEG parameter R time and coagulation parameters(PT,APTT)were tested in all included patients and the results were compared between 2 test methods.Results Consistency analysis results showed that the kappa values of TEG R time with PT and APTT in patients with chronic hepatitis were-0.135(P>0.05)and 0.105(P>0.05),the consistent rates were 34.15%and 60.98%respectively.For patients with compensatory cirrhosis,the kappa values of TEG R time with PT and APTT were 0.175(P<0.05)and 0.038(P>0.05),the consistent rates were both 60.9%.For patients with decompensated cirrhosis,the kappa values of TEG R time with PT and APTT were 0.023(P>0.05)and 0.038(P>0.05),the consistent rate was 43.04%and 49.37%.The kappa values of TEG R time with PT and APTT in patients with chronic liver failure were both-0.049(P>0.05),the consistent rate was both 13.95%.Conclusions Because of the difference of detection principle,the results of TEG can provide a more comprehensive basis for evaluating the coagulation factor status of patients at different stages of liver disease compared with routine coagulation testing.

关 键 词：血栓弹力图 凝血功能 一致性分析 

分 类 号：R446.11[医药卫生—诊断学] R575[医药卫生—临床医学]