血栓弹力图对脓毒症诱发凝血病的诊断及预后评估作用  

The Value of Thromboelastography in the Diagnosis and Prognosis of Sepsis-Induced Coagulopathy

作　　者：李俊玉 刘慧珍[1,2] 王雅慧[1,2] 冯永路[1,3] 商娜 王丰容 王娜[1,2] LI Jun-yu;LIU Hui-zhen;WANG Ya-hui;无(Capital Medical University School of Rehabilitation Medicine,Department of Emergency Medicine,Beijing 100068,China;Beijing Bo’ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Blood Transfusion,Beijing Bo’ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院急诊科,北京市100068 [3]中国康复研究中心北京博爱医院输血科,北京市100068

出　　处：《中国实验诊断学》2021年第11期1653-1658,共6页Chinese Journal of Laboratory Diagnosis

基　　金：中国康复研究中心科研项目(编号:2018zx-Q10);丰台区卫生计生系统科研项目(编号:2018-71)。

摘　　要：目的探讨血栓弹力图对脓毒症诱发凝血病(SIC)的诊断及预后评估作用。方法连续收集2018年12月至2020年9月中国康复研究中心急诊科收治的脓毒症患者150例,根据SIC评分系统将患者分为SIC组(64例)和非SIC(86例)组,根据SIC患者的预后分为存活组(21例)和死亡组(43例),分别比较两组间血栓弹力图R值、K值、α角、MA值及CI值,采用受试者工作特征(ROC)曲线评价血栓弹力图各指标对SIC的诊断及预后评估的临床价值。结果与非SIC组相比,SIC组R值、K值显著延长,α角、MA值及CI值显著降低(P<0.001);与存活组相比,SIC患者死亡组MA值和CI值降低,差异有统计学意义(P<0.05),两组R值、K值和α角差异无统计学意义(P>0.05)。ROC曲线分析显示,CI值对SIC的诊断能力较高,曲线下面积(AUC)为0.908,以-0.90为最佳分界点,其敏感度为0.828,特异度为0.930,约登指数为0.758,R值、K值、α角对SIC的诊断能力中等,AUC依次为0.712、0.813、0.802,MA值对SIC的诊断能力较低,AUC为0.700;MA值和CI值对SIC患者院内死亡的预测能力中等,AUC分别为0.733、0.774,与降钙素原(PCT)和乳酸对SIC患者的院内死亡预测能力相当(AUC分别为0.747、0.667)。结论血栓弹力图可以识别脓毒症患者的凝血功能障碍,在SIC诊断和预后评估中有重要的参考价值。Objective To assess the application value of thromboelastography in the diagnosis and prognosis of sepsis-induced coagulopathy(SIC).Methods From December 2018 to September 2020,data of thromboelastography were analyzed in 150 patients with sepsis admitted to the emergency department of China Rehabilitation Research Center.The patients were divided into SIC(64 cases)group and non-SIC group(86 cases)according to the SIC score and then the patients with SIC were divided into the survival group(21 cases)and non-survival group(43 cases).The value of thromboelastography in the diagnosis and prognosis of SIC was analyzed with receiver operator characteristic(ROC)curve.Results Compared to the non-SIC group,patients in the SIC group had significantly higher R and K values,a significantly lowerαangle,MA value and coagulation index(CI)(P<0.001).The MA value and CI was significantly lower(P<0.05)in the non-survival group than that in the survival group while there was no significant difference in R value,K value andαangle between the two groups(P>0.05).The area under the curve(AUC)of CI for excluding SIC was 0.908 and the cut-off point of exclusion was-0.90 with the Yoden index of 0.758,which yielded a sensitivity of0.828 and a specificity of 0.930.The AUC of R value and K value for diagnosing SIC were 0.712 and 0.813,respectively.The AUC ofαangle and MA value for excluding SIC were 0.802 and 0.700,respectively.The AUC of MA value and CI in predicting the death of patients with SIC during hospitalization was 0.733 and 0.774,which was similar to PCT and lactic acid(0.747 and 0.667 respectively).Conclusion Thromboelastography parameters have clinical value for the diagnosis and prognosis of SIC,which may help for guiding clinical therapy.

关 键 词：血栓弹力图 脓毒症诱发凝血病 诊断 预后评估 

分 类 号：R631[医药卫生—外科学]