慢性阻塞性肺疾病急性加重期患者血栓弹力图变化的初步研究  

A preliminary study on the changes of thrombelastography in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：李军 杨媛华[2] Li Jun;Yang Yuanhua(Sunhe Community Health Service Center,Chaoyang District,Beijing,100103,China;Department of Respiratory and Critical Care Medicine,Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]北京市朝阳区孙河社区卫生服务中心,北京100103 [2]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020

出　　处：《当代医学》2020年第23期1-5,共5页Contemporary Medicine

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者静脉血栓高危人群血栓弹力图(TEG)的变化,明确TEG对AECOPD患者血栓前状态(PTS)的诊断价值。方法选取2015年12月至2016年2月朝阳医院呼吸与危重症医学科收治的资料完整的高危AECOPD住院患者30例,另选取同期健康体检者10名。收集患者的人口学资料,在治疗前采集静脉血进行TEG、纤维蛋白原(Fbg)和D-二聚体(D-dimer)检查。根据AECOPD患者入院后是否进行抗凝预防,分为抗凝组和非抗凝组,并在治疗7 d后采集各组患者的静脉血复查TEG、Fbg和D-dimer。对治疗7 d后发生症状性DVT者进行下肢静脉超声检查以确诊。结果 AECOPD患者入院时TEG检测结果与健康组比较,凝血反应时间(R)缩短[(4.8±0.3)min vs.(7.1±1.6)min,P<0.001],凝血形成时间(K)缩短[(0.9±0.2)min vs.(2.2±0.4)min,P<0.001],凝固角增大(Angle)[(74.8±4.0)°vs.(58.7±5.5)°,P<0.001];最大振幅(MA)增大[(69.5±6.0)mm vs.(57.6±6.2)mm,P<0.001]。抗凝组治疗前后R值、K值、Angle、MA值变化比较差异有统计学意义(P<0.05)。治疗后,抗凝组R值、MA值与健康对照组比较差异无统计学意义,非抗凝组治疗前后各指标比较差异无统计学意义。AECOPD患者入院时Fbg和D-dimer值显著高于正常值;抗凝组治疗前后Fbg、D-dimer比较差异有统计学意义(P<0.05)。抗凝组和非抗凝组治疗后Fbg、D-dimer比较差异有统计学意义(P<0.05)。治疗7 d后,非抗凝组患者有2例发生症状性DVT。结论血栓弹力图可反映AECOPD患者的血栓前状态,但应用价值有限。Objective To explore the changes of thrombelastography in AECOPD patients with high risk of venous thromboembolism, and to identify the diagnostic value of TEG in the prethrombotic state of patients with AECOPD. Methods A total of 30 high-risk AECOPD inpatients with complete data who were admitted to the Department of Respiratory and Critical Care Medicine of Chaoyang Hospital from December 2015 to February 2016 were selected. In addition, 10 healthy patients were selected for the same period. Before treatment, patients’ demographic information,venous blood was collected for TEG, Fbg and D-dimer. According to whether the patients admitted to hospital after anticoagulation, divided into anticoagulant group and non anticoagulant group, and after 7 days of treatment, the venous blood of all patients were collected to review TEG, Fbg and D-dimer. After 7 days of treatment, the patients with symptomatic DVT were diagnosed by ultrasound examination. Results Admission in patients with AECOPD TEG results with those of the healthy group compared, coagulation reaction time(R) shorten [(4.8±0.3) min vs.(7.1±1.6) min, P<0.001], coagulation time(K) shorten [(0.9 ± 0.2)min vs.(2.2 ± 0.4) min, P<0.001], solidification angle increases(Angle) [(74.8 ± 4.0) ° vs.(58.7 ±5.5) °, P<0.001], maximum amplitude(MA) increases [(69.5±6.0) mm vs.(57.6±6.2) mm, P<0.001]. There was a statistically significant difference in the changes of R value, K value, Angle, MA value before and after treatment in the anticoagulant group(P<0.05). There was no significant difference in R value and MA value, after treatment anticoagulant group compared with healthy control group. There was no significant difference in the indexes of non anticoagulant group after treatment compared with before treatment. The value of Fbg and D-dimer was significantly higher than the normal values in AECOPD patients, and there was significant difference in Fbg and D-dimer after the treatment of anticoagulation group compared with before treatment(P<0.05). There was

关 键 词：血栓弹力图 血栓前状态 急性加重期 慢性阻塞性肺疾病 

分 类 号：R563.9[医药卫生—呼吸系统]