血栓弹力图预测肝病患者消化道出血的价值研究

The Study on the Value of Thrombelastogram Predict Short Term Alimentary Tract Hemorrhage in Patients with Hepatopath

目的用血栓弹力图(TEG)评价肝病不同阶段凝血功能的改变并探讨其预测短期消化道出血的临床价值。方法选择118例确诊为慢性乙型肝炎肝硬化病人,另选择无肝胆疾患,无血液系统疾病,未使用干扰凝血的药物,肝功能正常30例作为正常对照。所有患者均在入院时抽取静脉血4ml,其中2ml送检验科用于行常规凝血试验包括PLT、aPTT、PT-INR等,2ml用于进行TEG检测。并统计消化道出血的发生情况。结果以消化道出血为终点指标,以受试者工作特征曲线(ROC)下面积来衡量常用凝血试验指标和TEG检测指标预测慢性乙型肝炎肝硬化患者消化道出血的能力,常用凝血试验指标中INR的ROC曲线下面积最大(0.699),血小板的ROC曲线下面积最小(0.513);TEG指标中α角预测出血的ROC曲线下面积最大(0.812),LY30最小(0.624)。采用ROC曲线发现α角预测肝硬化患者短期消化道出血的临界值为44.6,低于44.6短期内发生消化道出血的灵敏度高达86.67%,特异度为67.96%。结论 TEG可全面反映肝硬化患者凝血紊乱状况,而且TEG检则中的α角较INR、血小板可更准确地预测肝硬化患者短期消化道出血的风险,具有良好的临床指导价值;α角预测肝硬化患者短期消化道出血的临界值为44.6。

Objective To appraise coagulation disorders in different hepatopath stage by thrombelastogram, and investi- gate the clinical value of thrombelastogram（TEG） predict short term alimentary tract hemorrhage in patients with liver disease. Methods 118 patients with established chronic HBV cirrhosis with chronic hepatitis B and 30 patients with normal liver func- tion not receiving agents interfere with coagulation without liver and gall disease nor hematological system disease were enrolled. All patients were sampled 4 ml venous blood at admission,2 ml was assessed using a computerised TEG as recommended by the manufacturer. The other 2 ml were tested by routine methods to obtain conventional parameter such as PLT, aPTT, PT-INR. Then analysis the relationship between these parameters and alimentary tract hemorrhage ratio. Results The primary endpoint was, the value of conventional coagulation parameter and TEG predict short gastrointestinal bleeding in patients with chronic HBV cirrhosis with chronic hepatitis B were compared by area under receiver operator characteristic curve （ROC） , the ROC area of INR is 0. 699 more then others ,the ROC area of PLT is the smallest only 0. 513. The ROC arer of a angle is 0. 812 which more than other parameters in TEG, the ROC area of LY30 is the smallest only 0. 624. We dicided the critical value of a angle as 44. 6 by ROC, the sensitivity for predict blot^ding was 86. 67% , and the specificity was 67. 96. Conclusion Thromboelastometry is suitable for overall assessing coagulation disorder in cirrhosis patients, the value of a angle among TEG parameters predict short gastrointesti- nal bleeding superior to INR and PLT. We speculate that it could be used with clinical benefit for cirrhostic patients ,the critical value of a angle is 44. 6.