血栓弹力图在评价不同营养状况血液透析患者凝血功能中的作用

Thromboelastograph in evaluation of blood coagulation of different nutritional status of hemodialysis patients

目的评价血栓弹力图(TEG)在诊断营养不良血液透析患者凝血功能障碍中的作用。方法选择30例维持性血液透析(MHD)患者和20例正常人,检测血红蛋白、血小板数量、凝血功能、白蛋白、前白蛋白、血脂和TEG。以主观综合性营养评估将患者分为营养不良组和营养正常组,比较三组以上指标的差异。结果 (1)MHD患者血红蛋白、血小板、高密度脂蛋白较对照组降低。营养不良的发生率为46.6%,营养不良患者白蛋白、前白蛋白、总胆固醇低于营养正常者(P<0.05)。(2)营养正常组患者常规凝血功能检查与对照组相比无显著性差异(P>0.05)。营养不良组与对照组比较,凝血酶原时间、国际标准化比值延长,纤维蛋白原升高(P<0.05);与营养正常组比较,常规凝血功能检查无显著性差异(P>0.05)。(3)与对照组相比,MHD患者TEG反应时间(R值)延长,凝血指数(CI)负值增大,营养不良患者最大振幅(MA值)增大(P<0.05)。营养不良组与营养正常组比较,MA值增大,CI负值增大(P<0.05)。结论 MHD患者常存在营养不良,凝血功能改变较为复杂,常规凝血功能结合TEG检查能够早期发现不同营养状况血透患者凝血功能的异常。

Objective To assess blood coagulation of different nutritional status of maintenance hemodialysis（MHD） patients by thromboelastograph（TEG）. Methods Thirty MHD patients were enrolled in this study and divided into two groups according to Subjective Global Assessment. Blood routine tests, serum biochemical indexes, conventional coagulation and TEG were measured. We also detected in 20 normal persons as control. Results （ 1 ） Hemoglobin, platelet and high-density lipoprotein in MHD patients were significant lower than those in the control group. The incidence of malnutrition was 46. 6%. Serum albumin, pre-albumin and total cholesterol in malnutrition group were evidently lower than those in normal nutrition group （P 〈 0. 05 ）. （2）There was no significant difference in conventional coagulation between normal nutrition group and control group（ P 〉 0. 05 ）. In malnutrition group,prothrombin time and international standardization ratio extended, fibrinogcn rose compared with the control （P 〈 0. 05 ） ;meanwhile, there was also no significant difference in conventional coagulation compared with normal nutrition group （ P 〉 0. 05 ）. （ 3 ） There was significant difference in TEG parameters among three groups. Compared with the control, TEG reaction time （ R value） extended, blood coagulation index （CI） negative value increased in MHD patients （ P 〈 0.05 ）, and maximum amplitude （MA） increased in malnutrition group. Compared with normal nutrition group, MA value and CI negative value increased in malnutrition group （P 〈 0.05 ）. Conclusion MHD patients often exist malnutrition,change of their blood coagulation function is more complicated. Conventional coagulation combined with TEG can be used to detect early coagulation abnormalities of different nutritional status of MHD patients.