健康成人血栓弹力图参考范围的确立

Normal reference range for thromboelastography in Lanzhou region healthy adult volunteers of Gansu Province

目的 血栓弹力图（TEG）可以对人体的凝血功能进行全面的评估.但是由于其正常值范围区域的差异性限制了它的应用.本研究通过测定甘肃兰州地区成人健康人群血栓弹力图的各个参考的范围值,分析与厂家提供的参考范围的差异性,综合性评估性别和年龄的影响,建立本地区的血栓弹力图的参考范围.方法 选取体格检查和实验室血常规检查均无异常,排除孕妇、正在服用抗凝药物或有出血症状,纳入健康成人共127名,其中男65名,女62名;采用TEG（R） 5000血栓弹力图检测仪,通过测定经高岭土激活的枸橼酸化的血样;对TEG的各个参数进行分析,主要包括R,K,α,MA,LY30及CI.结果 127名健康志愿者的TEG各个参数的正常参考范围分别为R：3.5～9.2 min,K：0.7～3.4 min,α：45.8～77.1°,MA：48.6～70.1mm,LY30：-1.9～5.4％,CI：-4.9～3.5;对比不同性别间的凝血功能,女性健康志愿者与男性相比具有更高的凝血活性;年龄与凝血活性并无显著的相关性;根据厂家提供的参考范围,约有9.6％的健康志愿者被诊断为凝血功能异常,检测的特异性为75％.结论 本实验支持了厂家的推荐,TEG临床实验室应根据本地区人群的特点,建立符合本地区健康成年人血栓弹力图的范围,以供临床诊断参考.

Objective Thromboelastography （TEG） provides a functional evaluation of coagulation. It is not fre- quently used, partially due to lack of normal values. To determine the thrombelastography （TEG） reference range of Lanzhou region＇s population for healthy adults. We determined normal values for our population, compared them to those of the manufacturer and evaluated the effect of gender and age. Methods 127 healthy adults volunteers （male 65, female 62） were interviewed. The technique was standardized using citrated blood, kaolin and was performed on a Haemoscope 5000 device （TEG--5000）. R, K, α, MA, LY30, and coagulation index were measured. Results R, K, α, MA, LY30 and CI of TEG normal reference range of the 127 healthy volunteers were 3.5~9.2 min, 0.7~3.4 min, 45.8~77.1°, 48.6~70. 1mm, --1.9~5.4% and --4.9~3.5. Indexes of healthy women were significantly more hypercoagulable than that of men. Aging was not associated with hypercoagulability. In our population, the manufacturer＇s normal values had a specificity of 74% and would incorrectly identify 9.6 ~ of the healthy volunteers as coagulopathic. Conclusion TEG of clinical laboratory should be based on the characteristics of the population of the region, and establishing regional refer- ence range for clinical diagnostic reference.