高血压及糖尿病人肾小球滤过率对血栓弹力图测定的凝血功能影响

Influence of GFR on coagulation function measured by TEG in patients with hypertension and/or diabetes mellitus

目的：利用改良的血栓弹力图技术（TEG）评估老年高血压病、糖尿病患者抗血小板治疗后凝血功能变化,探讨肾小球滤过率（eGFR）对TEG各指标的影响.方法：选择TEG、常规凝血功能检查资料完整的住院患者87例,根据eGFR分为eGFR正常组（eGFR≥90ml· min 1·1.73m-2）52例,以及eGFR低下组（eGFR＜ 90ml·min-1·1,73m-2） 35例,比较两组间服用抗血小板药物（阿司匹林和/或氯吡格雷）治疗后常规凝血功能和TEG指标的差异,分析eGFR与TEG指标间的相关性.结果：抗血小板治疗后,与eGFR正常组比较,eGFR低下组TEG; K时间[K值,（1.59±0.53） min比（1.35±0.48） min]显著减少（P=0.037）,α角度[Angle值,（66.05±7,63）＆#176;比（69.49±7.58）°、MA30min血块减少速度（Ly30）：（0.99±1.88）％比（2.80±4.60）％]显著增加;血浆纤维蛋白原水平[（2.96±0.65） mg/L比（3.60±1.08） mg/L]显著升高（P＜0.05～＜0.01）;Pearson相关性分析显示,Angle值（r=-0.308,P=0.008）、Ly30值（r=-0.258,P=0.03）均与eGFR呈负相关.结论：抗血小板治疗后高血压、糖尿病慢性肾功能损害患者血凝度仍高于肾功能正常患者;这些患者应定期检查肾功能和血栓弹力图,以评估抗血小板的效果.

Objective： To assess coagulation function change after antiplatelet therapy in aged patients with hyperten- sion and/or diabetes mellitus （DM） using modified thrombelastography （TEG）, and explore influence of estimated glomerular filtration rate （eGFR） on TEG indexes. Methods： According to eGFR, a total of 87 hospitalized patients with TEG and routine coagulation function data were enrolled and divided into normal eGFR group （n ： 52, eGFR≥90ml · min-1 . 1.73m-2） and low eGFR group （n= 35, eGFR〈90ml·min-1· 1.73m-2）. Routine coagulation function and TEG indexes after antiplatelet therapy （aspirin and/or clopidogrel） were compared between two groups, and the correlation among eGFR and TEG indexes were analyzed. Results： Compared with normal eGFR group after antiplatelet treatment, there was significant reduction in K time [K value, （1.59 ± 0.53） min vs. （1.35 ± 0.48） min, P = 0. 037], significant rise in angle a [Angle value, （66.05 ± 7.63） vs. （69.49 ± 7.58） , MA30min Clot reduce speed （Ly30） ： （0.99 ± 1.88） vs. （2. 80 ± 4.60）] in TEG; and the plasma level of fibrinogen [ （2. 96± 0.65） mg/L vs. （3.60 ± 1.08） mg/L] also significantly rose in low eGFR group, P（0.05-（0.01; Pearson correlation analysis indicated that Angle value （r = - 0. 308, P = 0. 008） and Ly30 （r = - 0. 258, P = 0.03） were inversely correlated with eGFR. Conclusion： After antiplatelet treatment, coagulation degree of patients with hypertension and/or DM complicated chronic renal damage is still higher than that of patients with normal renal function; for these patients, the renal function and thrombelastography should be regularly checked in order to assess antiplatelet effect.