细菌性肝脓肿血栓弹力图检查的临床意义  

Clinical significance of thromboelastography in pyogenic liver abscess

作　　者：倪主昂 陆晓晔[1] 杨伟强[1] 陈丽[1] 刘黎[1] 叶晨安[1] 朱长清[1] Ni Zhu-ang;Lu Xiao-ye;Yang Wei-qiang;Chen Li;Liu Li;Ye Chen-an;Zhu Chang-qing(Department of Emergency,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,上海200127

出　　处：《中国急救医学》2020年第5期404-410,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的通过对细菌性肝脓肿(pyogenic liver abscess,PLA)并发脓毒症患者常规凝血检查及血栓弹力图(thromboelastography,TEG)检测结果的分析,评价凝血功能指标是否适合作为细菌性肝脓肿并发脓毒症的生物标志物。方法回顾性入组2014年10月至2019年8月急诊科住院的65例诊断为PLA的患者,按照SEPSIS-3标准,分为非脓毒症组和脓毒症组,比较两组患者的常规凝血检查和TEG指标及C-反应蛋白(C-reactive protein,CRP)和降钙素原(procalcitonin,PCT)水平。绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线,并计算最佳截断值、敏感度和特异度。结果常规凝血检查参数中,脓毒症组纤维蛋白原(fibrinogen,FBG)明显高于非脓毒症组(P=0.035),凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、D-二聚体(D-Dimer,DD)、纤维蛋白(原)降解产物(fibrin/fibrinogen degradation products,FDP)比较差异无统计学意义(P>0.05);TEG参数中,凝血反应时间(R)、凝血形成时间(K)、凝血形成速率(α-angle)、最大振幅(MA)、凝血综合指数(coagulation index,CI)差异有统计学意义(P分别为0.007、0.001、0.000、0.002、0.000)。二元Logistic回归分析表明,α-angle是脓毒症的预测指标(OR=1.502,95%CI 1.147~1.967,P=0.003)。ROC曲线分析,α-angle的曲线下面积(area under curve,AUC)为0.713(95%CI 0.587~0.818,P=0.001),计算最佳截断点为76.9,敏感度为64.29%,特异度为72.97%;MA的AUC为0.708(95%CI 0.582~0.814,P=0.002),计算最佳截断点为76.2,敏感度为35.71%,特异度为97.30%;CI的AUC为0.771(95%CI 0.650~0.866,P=0.000),计算最佳截断点为2.5,敏感度为71.43%,特异度为70.27%。结论PLA常并发凝血功能紊乱,常规凝血检查及TEG检测对综合判断PLA病情有重要意义,MA、α-angle和CI是肝脓肿并发脓毒症时可靠的生物标志物�Objective To ascertain the associations of the coagulopathy with the severity of the patients with pyogenic liver abscess(PLA)by analyzing conventional coagulation assay and thromboelastography(TEG)values,and to investigate whether coagulation function parameters are suitable as biomarkers for PLA complicated with sepsis.Methods Sixty-five patients diagnosed as PLA admitted to the emergency department from October 2014 to August 2019 were enrolled.The patients were classified into two groups(non-sepsis group and sepsis group)according to the guideline of SEPSIS-3.The routine coagulation test,TEG index,C-reactive protein(CRP)and procalcitonin(PCT)levels were compared between the two groups.To compare biomarkers,a receiver operating characteristic curve(ROC)was used and the best cut-off value,sensitivity,and specificity were calculated.Results Among the conventional coagulation parameters,fibrinogen(FBG)was significantly higher in the sepsis group than in the non-sepsis group(P=0.035).There were no significant differences in prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),thrombin time(TT),D-Dimer(DD)and fibrin/fibrinogen degradation products(FDP)between the two groups.Among the TEG parameters,the differences of coagulation reaction time(R),coagulation formation time(K),coagulation formation rate(α-angle),maximum amplitude(MA)and coagulation index(CI)were statistically significant(P was 0.007,0.001,0.000,0.002,0.000).Binary Logistic regression analysis showed thatα-angle was a predictor of sepsis(OR=1.502,95%CI 1.147-1.967,P=0.003).ROC analysis demonstrated area under the curve(AUC)of theα-angle was 0.713(95%CI 0.587-0.818,P=0.001).The calculated cut-off for theα-angle was 76.9,with the sensitivity of 64.29%and the specificity of 72.97%.ROC analysis demonstrated the AUC of MA was 0.708(95%CI 0.582-0.814),and the calculated cut-off for the MA was 76.2,with the sensitivity of 35.71%and the specificity of 97.30%.ROC analysis demonstrated the AUC of CI was 0.771(

关 键 词：细菌性肝脓肿(PLA) 脓毒症 血栓弹力图(TEG) 高凝状态 纤维蛋白溶解停止(SD) 

分 类 号：R575.4[医药卫生—消化系统]