急性冠状动脉综合征患者血栓弹力图与血小板参数的相关性分析

Relationship between thrombelastography test and routine platelet parameters in patients with acute coronary syndrome

目的:探讨血栓弹力图(TEG)与血小板参数之间的相关性及其在急性冠状动脉综合征(ACS)抗血小板治疗中的应用价值。方法:连续选择91例接受经皮冠状动脉介入治疗(PCI)的ACS患者,于PCI术后次日晨采集静脉血进行TEG检测,并同步测定血常规。结果:①血栓最大弹力度(MA)、血小板计数(PLTs)、血小板压积(PCT)分别在ACS不稳定性心绞痛(UA)组、急性非ST段抬高型心肌梗死(NSTEMI)组和急性ST段抬高型心肌梗死(STEMI)组间差异有统计学意义(均P<0.05);②ACS患者血小板参数中PLTs与TEG参数中血凝块形成时间(K)呈负相关(r=-0.251,P<0.05),与血凝块形成速度(Angle)、MA、凝血指数(CI)呈正相关(r=0.308,0.525,0.388;均P<0.01);PCT与K呈负相关(r=-0.239,P<0.05),与Angle、MA、CI呈正相关(r=0.327,0.477,0.390;均P<0.01);③PLTs与MA高度相关,但异常的PLTs对应的MA值范围较广泛。结论:ACS患者TEG与血小板参数之间存在相关性,二者联合监测对PCI术后抗血小板治疗具有一定的指导作用。

Objective：To evaluate the correlation between the thromboelastogram（TEG）and conventional platelet parameters and its effectiveness in determining the coagulation status in patients with acute coronary syndrome（ACS）undergoing percutaneous coronary intervention（PCI）.Method：A total of 91 patients with ACS were enrolled.R time,alpha angle,K time,maximal amplitude（MA）and coagulation index（CI）were measured by TEG while routine platelet parameters were tested simultaneously after PCI.Result：There were statistical differences in MA,platelet count（PLTs）and plateletcrit（PCT）among the three groups of ACS patients（all P〈0.05）.The PLTs was negatively correlated with K time（r=-0.251,P〈0.05）and positively associated with alpha angle,MA and CI（r=0.308,0.525,0.388;P〈0.01）respectively.The PCT was negatively correlated with K time（r=-0.239,P〈0.05）and positively associated with alpha angle,MA and CI（r= 0.327,0.477,0.390;P〈0.01）respectively.Some MA values corresponding with platelet count beyond normal references remain in the normal range.Conclusion：There is relationship between TEG-based indicators and platelet parameters in ACS patients undergoing PCI.The combination of the two methods may help to monitor the coagulation status to ensure the security of antithrombotic therapy.