血栓弹力图最大血块强度值对脓毒症患者血小板减少预测价值的研究

A research: Predictive value of maximal amplitude in thrombelastogram for thrombocytopenia of patients with sepsis

目的:探索血栓弹力图(TEG)最大血块强度(MA)值对脓毒症患者血小板减少的预测价值。方法:选取在医院诊治的67例脓毒症患者,将其根据血常规中血小板计数分为血小板减少组(21例)及非血小板减少组(46例),观察患者入院7 d中血小板的变化趋势,比较两组各凝血指标及血小板计数对血小板降低的预测价值。结果:(1)血小板减少组与非血小板减少组比较,患者病情更重,急性生理学和慢性健康评估(APARCHⅡ)评分、序贯器官衰竭估计(SOFA)评分显著增高、肝脏功能显著损伤,血清谷草转氨酶自然对数函数(Ln AST)值显著增加,血清白蛋白(ALB)值显著降低,两组比较差异有统计学意义(t=-6.920,t=-7.375,t=-2.069,t=3.033;P<0.05);(2)相关性分析发现,TEG参数MA值与血小板计数、血小板降低中度相关;与TEG(K值,a角)高度相关;与凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶原时间国际标准化比值(INR)、血浆纤维蛋白酶原(FIB)及D2聚体轻度相关性;与血清中Ln AST、SOFA评分及APARCHⅡ评分轻度相关;(3)多元逐步向后logistic回归提示,MA值可进入SOFA评分及APARCHⅡ回归方程,OR=0.733,95%置信区间(CI)为0.596~0.900,P=0.003;OR=0.714,95%CI为0.567~0.900,P=0.004;(4)受试者操作特性曲线发现,MA对于血小板减少预测的曲线下面积为0.820(9.714~0.926),P<0.001。结论:MA较血小板计数及普通凝血指标更能反映疾病的严重程度,可有效预测血小板进行性下降。

Objective： To explore the predictive value of maximal amplitude （MA） in thrombelastogram （TEG） for thrombocytopenia of patients with sepsis. Methods： 67 patients with sepsis were divided into thrombocytopenia group （21 cases） and non-thrombocytopenia group （46 cases） according to the blood platelet count of blood routine examination. The variation trends of blood platelet of patients during in 7d since they were hospitalized were observed and the predictive value of various coagulation indicators and blood platelet count for thrombocytopenia were compared. Results： （1）The acute physiology and chronic health evaluation II（ APACHE II） score and sequential organ failure assessment （SOFA） score of thrombocytopenia group were significantly higher than these of non- thrombocytopenia group, and the Ln AST that was a indicator of liver dysfunction of thrombocytopenia group also was significantly higher than that of non- thrombocytopenia group while the other indicator （ALB） of liver dysfunction of thrombocytopenia group was significantly lower than that of non- thrombocytopenia group （t=-6.920, t=-7.375, t=-2.069, t=3.033; P〈0.05）. （2） As the correlation analysis, the MA of TEG were moderate correlations with blood platelet count and thrombocytopenia, respectively. And it was high correlations with K value and a angle, respectively. Besides, it were slight correlations with prothrombin time （PT）, activated partial thromboplastin time （APTT）, international normalized ratio（INR）, fibrinogen （FIB） of plasma and D-dimer, respectively. And, there were also slightly correlations between it and Ln AST, SOFA scores and APACHE II scores, respectively. （3） As the results of multiple Logistic regression, MA value were independent factors for thrombocytopenia, the odd ratio （OR） and its 95% confidence interval （95%CI） in equation of SOFA scores were 0.733 and 0.596-0.900 （P=0.003）, respectively. And they were 0.714 and 0.567-0.900 （P=0.004） in equation of APARCHII scores, respectively. （4） The results of receiver operating characteristic （ROC） curve revealed that MA （area under the curve was 0.820 and the 95% CI was 0.714-0.926, P〈0.001） was strong predictor for a subsequent thrombocytopenia. Conclusion： Compared with platelet count and common coagulation biomarkers, MA is a better indicator to reflect the severity of sepsis and it can effective predict the progressive decrease of platelet.