血栓弹力图对心功能Ⅲ~Ⅳ级心力衰竭患者凝血状态的预测价值研究  

The predictive value of thromboelastography in evaluating coagulation status in heart failure patients with cardiac function gradeⅢ-Ⅳ

作　　者：许蕊 刘志强 范远华 李红梅[1] 漆波[1] 程杨 XU Rui;LIU Zhiqiang;FAN Yuanhua;LI Hongmei;QI Bo;CHENG Yang(Department of Cardiovascular Medicine,903 Hospital,Mianyang,Sichuan 621700,China)

机构地区：[1]九〇三医院心血管内科,四川绵阳621700

出　　处：《医药前沿》2024年第35期5-8,共4页Journal of Frontiers of Medicine

基　　金：四川省医学会(恒瑞)科研课题(2021HR47)。

摘　　要：目的:分析血栓弹力图(TEG)各指标对心功能Ⅲ~Ⅳ级心力衰竭患者凝血状态的预测价值。方法:收集2021年9月—2023年9月九〇三医院心血管内科病房收治的心功能Ⅲ~Ⅳ级的心力衰竭患者相关资料,检测患者的常规凝血指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)等]以及TEG指标[凝血反应时间(R)、凝血形成时间(K)和血细胞凝集块形成速率(Angle)、最大血块强度(MA)、凝血综合指数(CI)等]。分析TEG各指标与常规凝血指标的相关性,比较TEG与常规凝血指标评价患者凝血功能的诊断效能,从而分析TEG对心功能Ⅲ~Ⅳ级心力衰竭患者凝血功能的评估价值。结果:共纳入208例Ⅲ~Ⅳ级心力衰竭患者,筛查出32例合并下肢深静脉血栓形成(DVT),发生率为15.4%。DVT阳性与阴性患者的基础疾病发生率、性别、年龄比较,差异无统计学意义(P>0.05),DVT阳性患者的D-D高于阴性患者,APTT低于阴性患者,差异有统计学意义(P<0.05)。DVT阳性与阴性患者的TEG各项指标比较,差异无统计学意义(P>0.05)。D-D、R、K、MA的AUC比较,差异无统计学意义(P>0.05)。TEG与常规凝血指标相关性分析:R、K、Angle、CI与APTT、PT、FIB指标具有相关性(P<0.05)。结论:TEG对心功能Ⅲ~Ⅳ级心力衰竭患者的纤溶系统评估及出血风险评估意义较大。Objective To analyze the predictive value of thrombelastography(TEG)parameters for coagulation status in heart failure patients with New York Heart Association(NYHA)functional classⅢ-Ⅳ.Methods The relevant data of heart failure patients with cardiac function gradeⅢ-Ⅳadmitted to the Department of Cardiovascular Medicine of 903 Hospital from September 2021 to September 2023 were retrospectively analyzed.Thromboelastography and hemagglutination tests were performed at the same time.The routine coagulation indexes[plasma prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(D-D),etc]and TEG indexes[reaction time(R),kinetic time(K),the blood clot formation rate(Angle),maximum blood clot strength(MA),coagulation index(CI),etc]were detected.The correlation between TEG indexes and routine coagulation indexes was analyzed,and the diagnostic efficacy of TEG and routine coagulation indexes in evaluating coagulation function of patients was compared,so as to analyze the coagulation function of TEG in patients with heart failure of cardiac function grade III-IV.Results Among 208 patients with gradeⅢ-Ⅳheart failure,32 patients(15.4%)were diagnosed with deep venous thrombosis(DVT).There was no significant difference in the incidence of underlying diseases,gender and age between DVT positive patients and DVT negative patients(P>0.05).The D-D of DVT positive patients was higher than that of negative patients,and APTT was lower than that of negative patients,the difference was statistically significant(P<0.05).There was no significant difference in the indexes of TEG between DVT positive and negative patients(P>0.05).There was no significant difference in AUC of D-D,R,K and MA value(P>0.05).Correlation analysis between thrombelastography and traditional coagulation function tests:R,K,Angle and CI were correlated with APTT,PT and FIB(P<0.05).Conclusions TEG has great significance in the evaluation of fibrinolysis system and bleeding risk in patients with gradeⅢ-Ⅳheart failure.

关 键 词：血栓弹力图 心功能 心力衰竭 凝血状态 

分 类 号：R541[医药卫生—心血管疾病]