血栓弹力图参数评估乙型肝炎肝硬化合并食管胃底静脉曲张破裂出血的意义  

Significance of thromboelastography parameters in evaluating hepatitis B cirrhosis complicated with esophageal-gastric varices bleeding

作　　者：孙梦秋 张爱霞 张莉[1] 林子曦 SUN Meng-qiu;ZHANG Ai-xia;ZHANG Li;LIN Zi-xi(Department of Blood Transfusion,Xuzhou Central Hospital,Jiangsu 221000,China;Department of Blood Transfusion,the Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州市中心医院输血科,江苏221000 [2]徐州医科大学附属医院输血科

出　　处：《肝脏》2024年第9期1091-1095,共5页Chinese Hepatology

基　　金：江苏省科技计划项目(BK20210081)。

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食管胃底静脉曲张破裂出血的意义。方法选取徐州市中心医院于2021年2月—2023年2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,将乙型肝炎肝硬化患者分为出血组(n=20)和未出血组(n=20)。将出血组随机分为A组(n=10)和B组(n=10),A组给予常规凝血试验指导输血,B组给予TEG试验指导输血。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,绘制ROC曲线来分析TEG检验结果与常规凝血实验的评估价值,比较A、B两组预后情况和输血成分用量。结果乙型肝炎肝硬化患者出血组和未出血组血小板计数(PLT)及纤维蛋白原(FIB)水平均显著小于对照组,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)水平均显著大于对照组(P<0.05);出血组的PLT及FIB水平显著小于未出血组[PLT:(67.13±33.18)vs.(84.23±29.34)×10^(9)/L;FIB:(1.47±0.49)vs.(1.97±0.52)g/L,P<0.05];出血组和未出血组的血凝块形成时间(K)显著高于对照组,凝固角(α)、最大振辐(MA)水平显著低于对照组(P<0.05);出血组的α角及MA水平[分别为(45.45±5.79)deg和(40.71±5.25)mm]显著小于未出血组[分别为(51.34±5.14)deg和(48.46±6.08)mm,P<0.05];PLT、FIB、α角及MA曲线下面积均超过0.5(P<0.05),且α角曲线下面积最大;B组预后好转率显著大于A组(100%vs.60%),住院天数为(9.12±1.02)d,显著小于A组(11.48±1.25)d,(P<0.05);B组红细胞和血浆[分别为(3.14±0.67)U和(534.07±80.42)mL]用量小于A组[分别为(4.11±0.74)U和(617.18±90.51)mL],血小板和冷沉淀用量[分别为(0.32±0.07)U和(33.48±6.25)U]显著大于A组[分别为(0.25±0.06)U和(28.12±5.02)U](P<0.05)。结论TEG凝血测试比标准凝血酶原时间、血小板计数和国际标准化比值等常规凝血测试更能指导患者输血管理,其中α角Objective To investigate the importance of thromboelastography(TEG)in the evaluation of hepatitis B liver cirrhosis associated with esophageal and gastric varicose bleeding.Methods A total of 40 patients with hepatitis B liver cirrhosis admitted to Xuzhou Central Hospital from February 2021 to February 2023 and 20 patients who underwent a healthy physical examination during the same period were included.The healthy physical examination population was included as a control group,and patients with hepatitis B cirrhosis were divided into a bleeding group(n=20)and a non-bleeding group(n=20).The bleeding group was randomly divided into group A(n=10)and group B(n=10),with group A and group B taking a routine coagulation test and a TEG test to guide blood transfusion respectively.The ROC curve was designed to compare the results of the TEG test with the index of agglutination function in the bleeding group,non-bleeding group and control group,and to analyze the equilibrium value of the results of the TEG test and conventional coagulation test,as well as the prognosis and dosage of the transfusion components of groups A and B.Results The platelet count(PLT)and fibrinogen(FIB)levels in the bleeding group and the non-bleeding group were significantly lower than those in the control group,while the levels of prothrombin time(PT),international normalized ratio(INR)and activated partial thromboplastin time(APTT)were significantly higher than those in the control group(P<0.05).The levels of PLT and FIB in the bleeding group were significantly lower than those in the non-bleeding group[PLT:(67.13±33.18)vs.(84.23±29.34)×10^(9)/L;FIB:(1.47±0.49)vs.(1.97±0.52)g/L,P<0.05];The blood clot formation time(K)of the bleeding group and the non-bleeding group were significantly higher than those in the control group,and the coagulation angle(α)and maximum vibration radiation(MA)levels were significantly lower than those in the control group(P<0.05).Theαangle and MA levels in the bleeding group[(45.45±5.79)deg and(40.71±5.25)mm,res

关 键 词：血栓弹力图参数 乙型肝炎肝硬化 食管胃底静脉曲张破裂出血 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]