血栓弹力图参数评估乙型肝炎肝硬化合并消化道出血的意义  

The significance of thromboelastography in evaluating hepatitis B related cirrhosis complicated with gastrointestinal bleeding

作　　者：陈慧园 陈苒 刘波 石雪梅 原霞 郭清江[2] 张琼[3] CHEN Hui-yuan;CHEN Ran;LIU Bo;SHI Xue-mei;YUAN Xia;GUO Qing-jiang;ZHANG Qiong(Department of Blood Transfusion,the Third People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Clinical research center of the first People′s Hospital of Bengbu,Anhui 230000,China;Department of Blood Transfusion,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区第三人民医院输血科,乌鲁木齐830000 [2]蚌埠市第一人民医院临床研究中心,安徽230000 [3]新疆医科大学第一附属医院输血科,乌鲁木齐830000

出　　处：《肝脏》2023年第11期1296-1300,共5页Chinese Hepatology

基　　金：新疆维吾尔自治区自然科学基金项目(2020D01A113)。

摘　　要：目的探究血栓弹力图参数(TEG)评估乙型肝炎肝硬化合并消化道出血的意义。方法选取新疆维吾尔自治区第三人民医院2018年5月—2019年5月收治的40例乙型肝炎肝硬化患者以及同期20例行健康体检人群为研究对象。将健康体检人群纳为对照组,根据乙型肝炎肝硬化患者是否合并消化道出血为依据,将乙型肝炎肝硬化患者分为出血组(n=20)和未出血组(n=20)。根据是否应用血凝酶将出血组分为治疗组(n=10)和非治疗组(n=10)。比较出血组、未出血组与对照组的常规凝血功能指标以及TEG检验结果,比较消化道出血患者血凝酶治疗组与非治疗组TEG参数,应用多元线性回归模型分析TEG对指导血凝酶用药的影响因素。结果乙型肝炎肝硬化患者出血组和非出血组血小板计数(PLT)及纤维蛋白原(FIB)水平[出血组分别为(67.1±33.2)×10^(9)/L、(1.4±0.4)g/L;未出血组分别为(84.2±29.4)×10^(9)/L、(1.9±0.5)g/L],均显著小于对照组[分别为(190.6±47.3)×10^(9)/L、(2.9±0.5)g/L,P<0.05],而凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)水平[出血组分别为(15.3±3.4)s、(1.3±0.3)、(38.1±5.0)s;非出血组分别为(15.4±3.5)s、(1.3±0.2)、(36.4±5.2)s]均显著大于对照组[分别为(10.4±0.8)s、(0.9±0.1)、(26.4±3.1)s,P<0.05];出血组的PLT及FIB水平显著小于未出血组;乙型肝炎肝硬化患者出血组和未出血组的血凝块形成时间(K)[分别为(3.3±0.5)min、(3.4±0.5)min]显著高于对照组[(2.2±1.4)min,P<0.05],凝固角(α)、最大振辐(MA)水平[出血组为(45.4±5.7)deg、(40.7±5.2)mm;未出血组为(51.3±5.1)deg、(48.4±6.0)mm]显著低于对照组[分别为(60.3±6.7)deg、(58.6±7.3)mm,P<0.05];肝硬化出血患者治疗组K值为(7.4±3.0)min,显著大于非治疗组的(3.0±1.0)min(P<0.05),治疗组α角和MA值[分别为(46.2±5.8)deg、(32.8±8.0)mm]显著小于非治疗组[分别为(58.4±7.3)deg、(42.3±6.8)mm,P<0.05];TEG检�Objective To explore the significance of thromboelastography parameters(TEG)in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Methods Forty patients with hepatitis B-related cirrhosis who were treated in our hospital from May 2018 to May 2019 were enrolled as the research objects.Twenty healthy people who underwent physical examination during the same period of time were included as the control.group.According to whether the cirrhotic patients were complicated with gastrointestinal bleeding,the patients were divided into a bleeding group(n=20)and a non-bleeding group(n=20).The conventional coagulation function indexes and TEG test results were compared between the bleeding group,the non-bleeding group and the control group.Receiver operating characteristic curve(ROC)was drawn to analyze the value of TEG test results and conventional coagulation test in evaluating hepatitis B-related cirrhosis complicated with gastrointestinal bleeding.Results The platelet count(PLT)and fibrinogen(FIB)levels in the bleeding and non-bleeding groups of patients with hepatitis B-related cirrhosis were(67.1±33.2)×10^(9)/L and(1.4±0.4)g/L,respectively;The non-bleeding group was(84.2±29.4)×10^(9)/L and(1.9±0.5)g/L],respectively,which were significantly lower than those in the control group[(190.6±47.3)×10^(9)/L,(2.9±0.5)g/L,respectively,P<0.05].While the levels of prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT)in the bleeding group were[(15.3±3.4)s,(1.3±0.3),and(38.1±5.0)s,respectively;which were significantly longer than those of(15.4±3.5)s,(1.3±0.2),and(36.4±5.2)s in the non-bleeding group,and those of(10.4±0.8)s,(0.9±0.1),and(26.4±3.1)s in the control group respectively(P<0.05];The PLT and FIB levels in the bleeding group were[(67.1±33.2)×10^(9)/L and(1.4±0.4)g/L,respectively,which were significantly lower than those of(84.2±29.4)×10^(9)/L and(1.9±0.5)g/L in the non-bleeding group[P<0.05];The blood clot formation time

关 键 词：血栓弹力图参数 乙型肝炎肝硬化 消化道出血 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学] R573