血栓弹力图和传统凝血指标检测在缺血性脑血管病中的相关性研究  

The comparative study between thromboelastography and conventional coagulation tests in ischemic cerebral vascular disease

作　　者：闫彬 胡天喜[1] 李新[1] 陆士奇[2] 王琪[3] 徐广建 裴双 赵益明[3] 阮长耿[3] Yan Bin;Hu Tianxi;Li Xin;Lu Shiqi;Wang Qi;Xu Guangjian;Pei Shuang;Zhao Yiming;Ruan Changgeng(Department of Clinical Laboratory Medicine,Nanyang Central Hospital,Nanyang 473000,China;Department of Emergency,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Jiangsu Institute of Hematology,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurology,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]河南省南阳市中心医院检验科,473000 [2]江苏省苏州大学附属第一医院急诊科,215006 [3]苏州大学附属第一医院,江苏省血液研究所,卫生部血栓与止血重点实验室,215006 [4]河南省南阳市中心医院神经科,473000

出　　处：《中华急诊医学杂志》2019年第12期1490-1495,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金面上项目(81873431);江苏省自然科学基金面上项目(BK20181164)。

摘　　要：目的探索血栓弹力图(TEG)和传统凝血功能试验(CCTs)检测在缺血性脑血管病(ICVD)中的相关性和一致性。方法回顾性分析2018年5月1日至10月31日在南阳市中心医院就诊的108例ICVD患者的TEG参数(R值、K值、Angle值、MA值、CI值和G值)和CCTs参数(PT、APTT、TT和FIB),分别采用Spearman秩相关和Kappa值(κ)探索TEG与CCTs参数之间的相关性以及在判断患者凝血状态时的一致性。利用ROC曲线分析TEG参数对CCTs异常结果的预测价值,综合分析TEG和CCTs结果,评估在预测患者凝血状态上的能力。结果(1)PLT与MA值、G值呈正相关;PT、APTT与K值呈正相关;TT与R值、K值呈正相关;FIB与Angle值、MA值、G值呈正相关。TT与Angle值、CI值呈负相关;FIB与K值呈负相关;(2)PT与MA值、PT与G值、FIB与MA值、FIB与G值在评估ICVD患者低凝状态时具有一致性;(3)PLT与Angle值、PLT与MA值、PLT与CI值、PLT与G值在评估ICVD病患者高凝状态时具有一致性;FIB与Angle值、FIB与MA值、FIB与CI值、FIB与G值在评估ICVD病患者高凝状态时具有一致性;(4)K值、Angle值判断TT>20 s的AUC分别为0.648、0.651;Angle值、MA值判断FIB>4 g/L的AUC分别为0.717、0.747;MA值判断PLT>300×109/L的AUC为0.808(均P<0.05)。结论TEG和CCTs参数在ICVD患者检测中的相关性较弱,在评估患者凝血状态时具有一定的一致性。TEG参数在判断CCTs异常结果上具有较好的预测价值,但无法取代CCTs检测。利用方法上优势互补,项目上优化组合将能更好地反映机体的凝血状态,指导临床。Objective To explore the correlation and consistency between thromboelastography(TEG)and traditional coagulation tests(CCTs)in ischemic cerebral vascular disease(ICVD).Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 312018 were enrolled.Patients’TEG parameters(R value,K value,Angle value,MA value,CI value and G value)and CCTs parameters(PT,APTT,TT,and FIB)were collected and analyzed retrospectively.The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters,and Kappa(κ)to explore the consistency in determining the coagulation status of the patients.The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs,and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.Results(1)PLT was positively correlated with MA value and G value;PT and APTT were positively correlated with K value;TT was positively correlated with R value and K value;FIB was positively correlated with Angle value,MA value and G value.TT was negatively correlated with Angle value and CI value;FIB was negatively correlated with K value.(2)PT and MA values,PT and G values,FIB and MA values,FIB and G values were accordant in valuing the hypoxic state of ICVD patients.(3)PLT and Angle values,PLT and MA values,PLT and CI values,PLT and G values were accordant in assessing hypercoagulable status of ICVD patients;FIB and Angle values,FIB and MA values,FIB and CI value,and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients.(4)For detecting TT>20 s,the AUC of K value and Angle value were 0.648,0.651,respectively;For detecting FIB>4 g/L,the AUC of Angle value and MA value were 0.717 and 0.747,respectively;For detecting PLT>300×109/L,the AUC of MA value was 0.808(all P<0.05).Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients.The TEG parameters have good predictive

关 键 词：血栓弹力图 传统凝血试验 缺血性脑血管病 缺血性脑卒中 相关性 

分 类 号：R74[医药卫生—神经病学与精神病学]