应用未成熟血小板和血栓弹力图评估血液毒毒蛇咬伤出血风险的研究  

Study on the application of immature platelet and thromboelastography in assessing the risk of hemorrhage after blood-poisonous snake bite

作　　者：吴晓[1] 蓝淑琴 龚恩来 叶慧贞 兰频[2] Wu Xiao;Lan Shuqin;Gong Enlai;Ye Huizhen;Lan Pin(Clinical Laboratory,The Fifth Affiliated Hospital of Wenzhou Medical University,Li Shui 323000,China;Department of Emergency Medicine,The Fifth Affiliated Hospital of Wenzhou Medical University,Li Shui 323000,China)

机构地区：[1]温州医科大学附属第五医院检验科,丽水323000 [2]温州医科大学附属第五医院急诊医学科,丽水323000

出　　处：《中华劳动卫生职业病杂志》2025年第2期134-138,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：丽水市公益性技术应用研究项目(2022GYX31)。

摘　　要：目的探讨未成熟血小板和血栓弹力图(thromboelastography,TEG)相关指标在血液毒毒蛇咬伤患者出血倾向评估中的价值。方法于2023年12月,采用出血评分系统对147例血液毒毒蛇咬伤患者进行出血评分及出血程度分级,进行未成熟血小板和TEG检测,分析患者出血程度与TEG、未成熟血小板比率(immature platelet fraction,IPF)、未成熟血小板绝对值(absolute value of immature platelets,A-IPF)等指标的相关性。计量资料符合正态分布用±s表示,多组间比较用方差分析;计数资料分析用χ^(2)检验;用Spearman等级相关分析出血程度与血小板计数(platelet count,PLT)、未成熟血小板、TEG指标的相关性;用Pearson线性相关分析PLT、未成熟血小板、TEG各项指标的相关性;用受试者工作特征曲线对未成熟血小板和TEG各指标进行分析。结果147例患者按照出血分数进行出血严重程度分级分为轻度组(22例)、中度组(119例)和重度组(6例),三组间患者年龄、性别及咬伤至就诊时长等临床资料差异无统计学意义(P>0.05)。随毒蛇咬伤出血程度升高,患者的TEG参数中凝血反应时间(R值)、血凝块形成时间(K值);IPF、A-IPF升高,PLT降低,差异均有统计学意义(P<0.05)。血液毒毒蛇咬伤患者PLT与IPF呈负相关(r=-0.301,P=0.012),与A-IPF无相关性(r=0.072,P=0.461);IPF与A-IPF呈正相关(r=0.722,P=0.000);PLT与TEG的凝固角(Angle角)、血栓最大振幅(MA)呈正相关(r=0.220、0.234,P=0.028、0.015),与R值、K值呈负相关(r=-0.368、-0.362,P<0.001),IPF与R值、K值呈正相关(r=303、271,P=0.020、0.035);IPF与MA值、Angle角无相关性(r=-0.087、-0.086,P=0.057、0.511),A-IPF与R值呈正相关(r=0.162,P<0.001)。患者出血程度与R值呈正相关(r=0.237,P<0.001),与K值、MA值、Angle角无相关性(P>0.05);患者出血程度与PLT呈负相关(r=-0.411,P<0.001)。ROC曲线分析结果显示R值、K值、MA值评估血液毒毒蛇咬伤患者出血风险效能较好,PLT联合A-IObjectiveTo explore the value of immature platelets and thromboelastography(TEG)in evaluating bleeding tendency in patients bitten by blood venomous snakes.MethodsIn December 2023,a bleeding scoring system was used to grade the bleeding score and degree of bleeding in 147 patients with blood venomous snake bites.Immature platelets and TEG were also tested to analyze the correlation between the bleeding degree of patients and indicators such as TEG,immature platelet ratio(IPF),and absolute value of immature platelets(A-IPF).The measurement data were represented by Mean±SD,and ANOVA was used for comparison among groups.Statistical data were analyzed usingχ^(2) test.Spearman correlation was used to analyze the correlation between bleeding degree and the platelet count(PLT),immature platelet and TEG.Pearson linear correlation was used to analyze the correlation of PLT,immature platelets and TEG.The indexes of immature platelets and TEG were analyzed by receiver operating characteristic curve.ResultsThe 147 patients were graded for bleeding severity based on their bleeding scores,and divided into mild(22 cases),moderate(119 cases),and severe groups(6 cases),and the clinical data such as age,gender and the time from bite to visit were compared among the three groups.The differences were not statistically significant(P>0.05).The coagulation reaction time(R),clot formation time(K),and immature platelet parameters(IPF,A-IPF)in TEG parameters increased with the degree of bleeding.PLT decreased with the degree of bleeding,and the difference was statistically significant(P<0.05).Blood venomous snake bite patients have a negative correlation between PLT and IPF(r=-0.301,P=0.012),but no correlation with A-IPF(r=0.072,P=0.461);PLT was positively correlated with coagulation Angle(αAngle)and maximum thrombus amplitude(MA)of TEG(r=0.220、0.243,P=0.028、0.015),but negatively correlated with R value and K value(r=-0.368、-0.362,P<0.001).IPF is positively correlated with R and K values(r=303、271,P=0.0020、0.035);IPF is not c

关 键 词：蛇咬伤 血栓弹力描记术 毒蛇 血液毒素 血常规 

分 类 号：R646[医药卫生—外科学]