凝血功能结果解释性规则的建立及应用  

Establishment and application of interpretative rules for results of coagulation function

作　　者：胡长爱[1] 伍秋淇 杨大干[1] HU Changai;WU Qiuqi;YANG Dagan(Department of Laboratory Medicine,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第一医院检验科,杭州310003

出　　处：《临床检验杂志》2022年第10期742-745,共4页Chinese Journal of Clinical Laboratory Science

基　　金：科技创新2030-"新一代人工智能"重大项目(2020AAA0109405)。

摘　　要：目的 建立成人凝血功能结果解释规则。方法 统计9 721份凝血功能5项的异常结果模式,参照专著、指南等建立解释性规则初稿。经过2轮专家合理性评分和修改形成终稿。用6 346份报告测试规则的应用,100份典型报告邀请专家评价解释的合理性。合理性评分采用5分制。结果 凝血功能5项的异常结果模式22种,建立结果解释性规则初稿13条。经过2轮20名专家合理性评分(从4.48分上升到4.64分)、建议和讨论,建立结果解释性规则15条,如:INR>1.15且APTT>38 s且TT 14.5~21.5 s且Fib<2.0 g/L,多见于肝脏疾病,当Fib<1.0 g/L提示严重肝病或发生出血。6 126份报告能触发解释性规则,100份报告5位专家的合理性评价为4.73分,符合率80%。结论 建立凝血功能结果解释规则,可提供初步解释性注释。Objective To establish an interpretation rules for the results of coagulation function in adults.Methods The abnormal results of coagulation function 5 items from 9721 samples were analyzed.The preliminary draft of interpretation rules was established based on monographs and guidelines.The rationality of the scores in the rules was explored though two rounds of consultations and modifications by experts based on the results,and then the final version of the interpretation rules was formed.A total of 6346 samples were interpreted using the developed rules and 100 typical reports of test results were evaluated by invited experts to verified the rationality of the rules and a 5-point scale system was adopted.Results A total of 22 types of abnormal modes for coagulation function 5 items were obtained,and 13 items of interpretative rules were initially established.Following consultations,discussions and suggestions of two rounds by 20 experts,15 interpretation rules were established,by which the rationality scores increased from 4.48 to 4.64.A typical example in the rule was as the follows:INR>1.15 and APTT>38 s and TT 14.5-21.5 s and Fib<2.0 g/L,these commonly occur in liver diseases,and Fib<1.0 g/L indicates severe liver disease or hemorrhage.A total of 6126 reports triggered the explanatory notes.The average score of 100 typical reports for their interpretation rationality from five experts was 4.73,and the coincidence rates of the evaluation of experts was 80%.Conclusion The interpretation rules of coagulation function results have been established,which may provide automatically the preliminary interpretative comments.

关 键 词：凝血功能 解释性注释 临床决策支持 规则库 

分 类 号：R446[医药卫生—诊断学]