血栓弹力图与常规凝血检验在慢性肾脏病中的应用价值分析  

Analysis of the practical value of thromboelastography and routine coagulation test in chronic kidney disease

作　　者：俞淼 张齐 YU Miao;ZHANG Qi(Department of Clinical Laboratory,Beijing First Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100026,China)

机构地区：[1]北京市第一中西医结合医院检验科,100026 [2]北京市朝阳区垡头社区卫生服务中心检验科,100020

出　　处：《中国现代药物应用》2024年第18期9-13,共5页Chinese Journal of Modern Drug Application

摘　　要：目的探讨慢性肾脏病检验中常规凝血、血栓弹力图的应用价值。方法135例慢性肾脏病患者,结合患者的疾病分期划分为5个组别,Ⅰ~Ⅱ期34例,计为A组;Ⅲ期27例,计为B组;Ⅳ期15例,计为C组,Ⅴ期未透析19例,计为D组;Ⅴ期透析40例,计为E组。所有患者均进行常规凝血检验和血栓弹力图检验。比较五组常规凝血检验指标[血浆凝血酶原时间(PT)、血浆凝血酶时间(TT)、血浆纤维蛋白原(FIB)、血浆D-二聚体(DD)、国际化标准比值(INR)]、血栓弹力图指标[凝血指数(CI)、凝固角(α)、反应时间(R)、凝血时间(K)、血栓最大幅度(Ma)],并分析其与慢性肾脏病疾病严重程度的相关性。结果五组患者PT、TT、FIB、DD、INR水平无统计差异(P>0.05)。A组患者CI(0.86±0.31)、α(74.89±1.89)°、R(7.80±0.15)min、K(1.80±0.11)min、Ma(55.91±1.99)mm,B组患者CI(1.40±0.42)、α(72.55±1.16)°、R(7.41±0.16)min、K(1.40±0.16)min、Ma(60.51±2.01)mm,C组患者CI(1.90±0.49)、α(70.61±1.01)°、R(6.91±0.10)min、K(1.20±0.12)min、Ma(63.30±2.21)mm,D组患者CI(2.30±0.56)、α(68.30±0.79)°、R(6.60±0.13)min、K(1.11±0.09)min、Ma(66.81±2.71)mm,E组患者CI(2.89±0.71)、α(65.60±0.78)°、R(6.20±0.11)min、K(1.01±0.08)min、Ma(71.30±2.82)mm。A组患者CI、Ma均比其他四组低,α、R、K比其他四组高(P<0.05);B组患者CI、Ma低于C组、D组、E组,α、R、K高于C组、D组、E组(P<0.05);C组患者CI、Ma低于D组、E组,α、R、K高于D组、E组(P<0.05);D组患者CI、Ma低于E组,α、R、K高于E组(P<0.05)。TT、PT、FIB、DD水平和慢性肾脏病疾病严重程度呈负相关,R、K、CI、Ma和慢性肾脏病疾病严重程度呈正相关(P<0.05)。结论对于慢性肾脏病,血栓弹力图检验敏感度较常规凝血检验更高,若两者联合检验,可获得更为精准的检验结果,有推广应用的价值。Objective To explore and analyze the practical value of thromboelastography and routine coagulation test in chronic kidney disease.Methods 135 patients with chronic kidney disease were selected.Based on the disease staging of the patients,they were divided into 5 groups:34 cases in stageⅠ-Ⅱwere classified as Group A,27 cases in stageⅢwere classified as Group B,15 cases in stageⅣwere classified as Group C,19 cases in stageⅤwithout dialysis were classified as Group D,and 40 cases in stage V with dialysis were classified as Group E.All patients underwent routine coagulation tests and thromboelastography.Comparison was made on routine coagulation test indexes[prothrombinogen time(PT),thrombin time(TT),fibrinogen(FIB),D-dimer(DD),and internationalized normal ratio(INR)],and the thromboelastography indicators[coagulation index(CI),alpha angle(α),reaction time(R),clotting time(K),and maximum amplitude(Ma)]among the five groups,and their correlation with the severity of chronic kidney disease was analyzed.Results There were no statistical differences in the levels of PT,TT,FIB,DD and INR among five groups(P>0.05).Group A had CI of(0.86±0.31),αof(74.89±1.89)°,R of(7.80±0.15)min,K of(1.80±0.11)min,and Ma of(55.91±1.99)mm;Group B had CI of(1.40±0.42),αof(72.55±1.16)°,R of(7.41±0.16)min,K of(1.40±0.16)min,and Ma of(60.51±2.01)mm;Group C had CI of(1.90±0.49),αof(70.61±1.01)°,R of(6.91±0.10)min,K of(1.20±0.12)min,and Ma of(63.30±2.21)mm;Group D had CI of(2.30±0.56),αof(68.30±0.79)°,R of(6.60±0.13)min,K of(1.11±0.09)min,Ma of(66.81±2.71)mm;Group E had CI of(2.89±0.71),αof(65.60±0.78)°,R of(6.20±0.11)min,K of(1.01±0.08)min,Ma of(71.30±2.82)mm.CI and Ma of Group A were lower than those of the other four groups,whileα,R,and K were higher than those of the other four groups(P<0.05);CI and Ma of Group B were lower than those of Group C and Group D,and Group E,whileα,R,and K were higher than those in Group C,Group D,and Group E(P<0.05);CI and Ma of Group C were lower than those in Group

关 键 词：慢性肾脏病 血栓弹力图 常规凝血检验 相关性 

分 类 号：R692[医药卫生—泌尿科学]