血栓弹力图在评估过敏性紫癜患儿凝血状态中的临床价值  

Clinical Value of Thrombelastography in Evaluating Coagulation in Children with Henoch-Schönlein Purpura

作　　者：阿比达·阿不来提 阿迪拉·阿不来提 张恩厅 朱洪涛[1] Abida ABULAIT;Adila ABULAIT;ZHANG Enting(School of Pediatrics,First Affiliated Hospital of Xinjiang Medical University,Xinjiang 830011,China)

机构地区：[1]新疆医科大学第一附属医院儿科学院,乌鲁木齐830011 [2]新疆医科大学公共卫生学院儿少卫生与妇幼保健学教研室,乌鲁木齐830011

出　　处：《医学研究杂志》2023年第5期88-93,共6页Journal of Medical Research

基　　金：新疆维吾尔自治区自然科学基金资助项目(2018D01C216)。

摘　　要：目的探讨血栓弹力图(thrombelastography,TEG)评估过敏性紫癜(henoch-schönlein purpura,HSP)患儿凝血状态中的临床价值。方法前瞻性连续收集2020年9月~2021年9月在新疆医科大学第一附属医院首次确诊为HSP患儿80例(病例组)和同期来院体检的健康儿童45例(对照组),对两组进行TEG与常规凝血检测,并对病例组进行远期随访,观察紫癜性肾炎(Henoch-Schönlein purpura nephritis,HSPN)发生率,进一步分析TEG对HSPN患儿高凝状态的诊断效能。结果病例组R值、K值均显著降低(P<0.05),而D-二聚体、Fib、α角则显著增大(P<0.05)。对TEG和常规凝血指标进行相关性分析发现,R值和APTT间呈正相关;K值和Fib间呈负相关;α角和APTT间呈负相关。随访6个月内,TEG阳性组患儿HSPN发生率为35.00%(28/80),显著高于TEG阴性组。D-二聚体、Fib、α角、K值和R值的敏感度分别为63.33%、20.00%、83.33%、70.00%和73.33%;特异性分别为55.10%、97.96%、60.00%、58.00%和66.00%。在所有单项指标中,相比其他指标α角敏感度和特异性较高,约登指数最高。结论TEG在评价HSP患儿高凝状态中有重要的作用;早期TEG呈高凝状态的HSP患儿中HSPN发生率较高,相较于D-二聚体和Fib,TEG对确定高凝状态有更好的诊断价值,对预测HSP患儿肾脏损害有一定价值。Objective To investigate the clinical value of thrombelastography(TEG)in predicting renal injury in children with Henoch-Schönlein purpura(HSP).Methods Prospective continuous collection of 80 children with HSP(case group)and 45healthy children(control group)who came to the hospital for physical examination from September 2020 to September 2021 in the First Affiliated Hospital of Xinjiang Medical University.Thrombelastogram,routine coagulation function and D-dimer were detected in the two groups,and the case group was followed up for long-term periods.The incidence of henoch-schönlein purpura nephritis(HSPN)was examined,and the diagnostic efficiency of TEG for hypercoagulable state in children with HSPN was further analyzed.Results the R and K of the case group were significantly decreased(P<0.05),while the D-dimer,Fib andɑangle were significantly increased(P<0.05).The correlation analysis between TEG and conventional coagulation indexes showed that there was a positive correlation between R and APTT.There was a negative correlation between K and Fib;there was a negative correlation betweenɑangle and APTT.Within six months of follow-up,the incidence of HSPN in the TEG positive group was 35.00%(28/80),which was significantly higher than that in the TEG negative group.The sensitivity of D-dimer,Fib,αangle,K and R was 63.33%,20.00%,83.33%,70.00%and 73.33%,respectively.The specificity was 55.10%,97.96%,60.00%,58.00%and 66.00%,respectively.Among all individual indicators,the sensitivity and specificity ofαangle were higher than those of other indicators,and the Yordon index was the highest.Conclusion TEG might play an important role in evaluating hypercoagulable state in children with HSP.The incidence of HSPN in children with early TEG hypercoagulable state was higher.Compared with D-dimer and Fib,TEG had better diagnostic value for determining hypercoagulable state and had certain value for predicting renal damage in children with HSP.

关 键 词：过敏性紫癜 血栓弹力图 常规凝血功能 D-二聚体 

分 类 号：R725.5[医药卫生—儿科]