摘要
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)°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.
出处
《心血管康复医学杂志》
CAS
2014年第6期619-622,共4页
Chinese Journal of Cardiovascular Rehabilitation Medicine