儿童血栓弹力图关键参数参考区间的建立和探讨  

Establishment of reference intervals for key parameters of thrombelastography in children

作　　者：郭凯 宋珊珊 邱立娟[1] 王笑欢 张慧敏[1] 王孟键 马曙轩[1] GUO Kai;SONG Shanshan;QIU Lijuan;WANG Xiaohuan;ZHANG Huimin;WANG Mengjian;MA Shuxuan(Department of Transfusion Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院输血科,北京100045

出　　处：《中国输血杂志》2020年第10期1019-1023,共5页Chinese Journal of Blood Transfusion

基　　金：首都医科大学科研培育基金(PYZ19033);首都医科大学附属北京儿童医院国家自然科学基金培育基金项目(GPY201802)。

摘　　要：目的探讨高岭土血栓弹力图(Thromboelastography,TEG)试验在检测儿童凝血功能中的关键参数参考区间(Reference interval,RI)。方法选取北京儿童医院2019年5月—2020年1月无凝血障碍的儿童1044例,采用美国血液技术公司血栓弹力图仪Thromboelastography®5000检测其凝血功能,分析TEG关键指标:凝血反应时间R(s)、凝血形成时间K(s)、凝固角α-Angle(°)、最大振幅MA(mm)及纤维蛋白溶解率LY30(%)。结果入选儿童常规凝血试验(Convention coagulation test,CCT)显示,PT、INR、APTT、FIB、D-二聚体、抗凝血酶Ⅲ活性以及血小板计数均正常。不同发育阶段(婴儿期、幼儿期、学龄前期、学龄期和青春期,未含新生儿期)或性别的儿童,其TEG检测结果未见明显差异(P>0.05),但男童LY30[0.10(0.10,0.30)]低于女童[0.10(0.10,0.50)](Hc=4.267,P<0.05)。儿童TEG关键参数参考区间为R:4.64-8.86、K:1.09—2.53、α-Angle:55.54—72.68、MA:51.50—69.06、LY30:(男:0—2.50,女0—3.30);根据临床意见调整后的参考区间为R:5—9、K:1—3、α-Angle:56—73、MA:52—69、LY30:(男:0—2.5,女0—3)。与Thromboelastography®5000厂家提供的TEG关键参数参考区间相比,R、K、α-Angle、MA和LY30均存在参考上限或下限不同,调整后的参考区间仅K值与其一致。结论TEG检测实验室需根据检测人群的具体特征建立相应参考区间,以更好地用于临床实践。Objective To explore the reference intervals(RIs)for key parameters of kaolin thromboelastography(TEG)in detecting blood coagulation function of children.Methods A total of 1044 children(range,0—18 yearsold)without clotting disorders were selected from May 2019 to January 2020 in Beijing Children′s Hospital.Blood coagulation functionwas detected using Thromboelastography®5000,and key indicators of TEGwere further analyzed,including:R(s)=time of latency from start of test to initial fibrin formation;K(s)=time taken to achieve a certain level of clot strength(amplitude of 20 mm);αangle(°)=measures the speed at which fibrin build up and cross linking takes place,hence assesses the rate of clot formation;MA(mm)=represents the ultimate strength of the fibrin clot;LY30(%)=percentage decrease in amplitude at 30 minutes post-MA and gives measure of degree of fibrinolysis.Results The conventional coagulation tests(CCTs)showed that PT,INR,APTT,FIB,D-dimer,antithrombin-Ⅲactivities and Pltwere normal.There were no significant differences in TEG test results for children at different developmental stages(infant,early childhood,preschool,school-age and adolescents,with neonatal periodexcluded)or gender(P>0.05).However,LY30 values of boys[0.10(0.10,0.30)]was lower than that of girls[0.10(0.10,0.50)](Hc=4.267,P<0.05).The RIs for key parameters of TEG in children were as follows:R,4.64—8.86;K,1.09—2.53;α-Angle,55.54—72.68;MA,51.50—69.06;LY30,Male:0—2.50,Female:0—3.30.According to clinical opinions,the TEG RIs were adjustedas follows:R,5—9;K,1—3;α-Angle,56—73;MA,52—69;LY30,male:0—2.5,female:0—3.In this study,R,K,α-Angle,MA and LY30 values demonstrated differentupper or lower limits in RIs incomparison with the referencesrecommendedby Thromboelastography®5000 manufacturer,andonly K value after adjustment was found to bewithin the recommendedlimits.consistent with that of the Thromboelastography®5000 manufacturer.Conclusion Establishing corresponding RIs according to the characteristics of test

关 键 词：血栓弹力图 儿童 凝血功能 关键参数 参考区间 

分 类 号：R457.1[医药卫生—治疗学] R722.1[医药卫生—临床医学]