血栓弹力图评估妇科恶性肿瘤患者凝血状态的研究  

Evaluation of coagulation status by thromboelastography in patients with gynecologic malignant tumors

作　　者：贾琳钰[1] 王辉[2] 姜苏娟 赵娜 卢发强[1] 付强[1] 高天明[1] 刘丽霞[1] JIA Linyu;WANG Hui;JIANG Sujuan(Department of Gynecology and Obstetrics,Zhongshan Hospital affiliated to Dalian University, Liaoning,Dalian 116000,China)

机构地区：[1]大连大学附属中山医院妇产科,辽宁省大连市116000 [2]大连医科大学附属第一医院急诊科,辽宁省大连市116000

出　　处：《河北医药》2020年第6期837-840,共4页Hebei Medical Journal

基　　金：大连市医学科学研究计划项目(编号:1811109)。

摘　　要：目的探讨血栓弹力图(TEG)在评价妇科恶性肿瘤患者凝血功能及预测血栓发生中的临床应用价值。方法选取2018年1月至2019年4月接受治疗的70例妇科恶性肿瘤患者,进行常规凝血(CCTs)、TEG和血常规检测。观察血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT),纤维蛋白原(FIB)、D-二聚体(D-D)、凝血因子作用时间(R)、凝血块形成初始时间(K)、凝血速率(Angle)、血小板功能参数(MA)、凝血综合指数(CI)及血小板计数(PLT)的TEG,并将TEG和CCTs检测的相关参数做回归分析,比较TEG、CCTs检测妇科恶性肿瘤患者的凝血功能的结果。结果R值主要反映内源性凝血因子的功能,Angle、K和MA均受凝血因子、FIB及PLT的多方面影响;MA与PLT是高度相关,但在提示患者血小板功能增强方面,血小板数量的增加远不及MA值确切;TEG检测妇科恶性肿瘤患者高凝状态的检出率高于CCTs的检出率,差异有统计学意义(P<0.05)。结论在妇科恶性肿瘤患者凝血功能的评估指标中,TEG、CCTs均具有重要临床价值,单独检测TEG对评价妇科恶性肿瘤患者凝血功能的效果优于CCTs,若能联合检测TEG、CCTs则有更加重要的临床价值。Objective To investigate the clinical application value of thromboelastography(TEG)in evaluating the coagulation function and predicting the incidence of thrombosis in patients with gynecologic malignant tumors.Methods A total of patients with gynecologic malignant tumors who were treated in our hospital from January 2018 to April 2019 were enrolled in the study.The plasma prothrombin time(PTT),activated partial thrombin time(APTT),fibrinogen(FIBB),D-dimer(D-D),coagulation time(RN)and clot formation time were observed.Moreover the parameters of TEG and CCTs were analyzed by means of regression analysis,including initial time,coagulation rate,platelet function parameter,coagulation index and platelet count.The sensitivity and specificity of simple TEG or simple CCTs and combination detection of both indexes in the evaluation of incidence thrombosis of patients with gynecologic malignant tumor were observed.Results Multiple regression analysis confirmed that the R value mainly reflected the function of endogenous coagulation factors.Both Angle,K and MA were affected by coagulation factor FIB and PLT in many aspects.However,it was suggested that there was a high correlation between MA and PLT.The increase in the number of platelets was far less than the correction of the MA value.The detection rate of hypercoagulability in patients with gynecological malignancies detected by TEG was higher than that of CCTs,and the difference was statistically significant.Conclusion TEG and CCTs have important clinical value in the evaluation of coagulation function in patients with gynecological malignant tumors.TEG is better than CCTs in evaluating the coagulation function of patients with gynecological malignant tumors.The combined detection of TEG and CCTs would have more important clinical value.

关 键 词：血栓弹力图 妇科恶性肿瘤 凝血功能检测 血栓 高凝状态 

分 类 号：R271.1[医药卫生—中医妇科学]