血栓弹力图与常规凝血检验在慢性肾脏病中应用比对分析

A comparative study on thrombelastography and routine coagulation tests in chronic renal diseases

目的 在慢性肾脏病（CKD）患者检测常规凝血检验、血栓弹力图（TEG）等指标,比对二者对CKD患者凝血状态的评估价值。方法 选取CKD患者108例,将其分为5组,即CKD 1~2期组、CKD 3期组、CKD 4期组、CKD 5期未透析组及CKD 5期透析组,观察各组CKD患者的常规凝血检验和TEG等指标变化及其与估算的肾小球滤过率（e GFR）的相关性。结果 ①凝血酶时间（TT）、血浆活化部分凝血酶原时间（APTT）、凝血酶原时间（PT）、国际标准化比值（INR）、纤维蛋白原（Fib）、D-二聚体（D-Dimer）值在CKD各组间均无统计学差异（P〉0.05）。②TEG的反应时间（R）、凝血时间（K）、血栓最大弹力度（MA）、凝固角（Angel）、凝血指数（CI）值在CKD患者各组的之间相比有统计学差异（P〈0.05）。③在除透析治疗外的CKD患者中进行常规凝血检验及TEG指标与e GFR的相关性分析,结果显示：R、K与e GFR呈正相关（P〈0.05）,D-Dimer值与e GFR呈负相关（P〈0.05）。结论 在慢性肾脏病患者中监测凝血状态,TEG检测相对于常规凝血检验更为敏感,将二者结合则给予临床治疗更多的提示。

Objective To explore and compare the clinical significance of routine coagulation tests and thromboelastography （TEG） in as- sessment of blood coagulation status in patients with chronic renal diseases （CKD）. Methods A total of 108 inpatients were enrolled and divided into 5 groups in accordance with the grading of renal dysfunction ： CKD stages 1 - 2, CKD stage 3, CKD stage 4 and CKD stage 5 without hemodi- alysis, and CKD stage 5 with hemodialysis, their routine coagulation tests, TEG and estimated glomerular filtration rate （eGFR） were analyzed and compared respectively. Results ① There was no statistical difference found in Tr, APTr, PT, INR, Fib and D - dimer among different groups （ P 〈 0.05 ）. ②Statistieal differences were noted in R, K, MA, Angel and CI value among different groups （ P 〉 0.05 ）. ③Correlation analysis of routine coagulation tests, TEG and eGFR demonstrated positive eorrelation among R, K and eGFR （ P 〈 0.05 ）, while negative correlation was found between D - Dimer and eGFR （ P 〈 0.05 ）. Conclusion TEG can be a choice of preference compared to routine eoagulation tests for its higher sensitivity in monitoring status of blood coagulation. A combination of both tests may bring more clinical implications.