血栓弹力图和常规凝血三项在患者凝血功能检测中的对比分析

Contrastive Analysis of Thromboelastography and Routine Coagulation Tests for Test of Blood Coagulation Function in Patients

目的对比分析血栓弹力图(TEG)与常规凝血三项(PT、aPTT、Fbg)的检测结果,探讨各参数间的相关性和Kappa一致性、灵敏度和特异度,评价两种方法在住院患者凝血功能检测中应用价值。方法回顾性分析华中科技大学同济医学院附属梨园医院和湖北省中山医院2016年1～10月3 081例住院患者的TEG和常规凝血三项的结果,将TEG和常规凝血三项的各参数结果进行相关性、Kappa一致性和配对卡方检验分析,并评价TEG和常规凝血三项试验在患者凝血功能检测中的灵敏度和特异度。结果 TEG R值与PT、aPTT呈线性相关(P <0. 001),TEG的K值、Angle、MA分别与Fbg呈线性相关(P <0. 001);出血患者TEG的R值与PT、aPTT的Kappa值分别为0. 1594、0. 1768,卡方检验结果分别为X^2=0. 64 (P> 0. 05)、X^2=21. 36 (P <0. 05); TEG的K值、Angle和MA值与Fbg的Kappa值分别为0. 1476、0. 1081、0. 3712,卡方检验结果分别为X^2=38. 06(P <0. 05)、X^2=130. 15(P <0. 05)、X^2=40. 09(P <0. 05); R值的检测灵敏度高于PT、aPTT,K值、Angle、MA检测的灵敏度均高于Fbg。血栓患者血栓弹力图R值与PT、aPTT的Kappa值分别为0、0. 0678,卡方检验结果分别为X^2=228(P <0. 05)、X^2=106. 85 (P <0. 05); TEG的K值、Angle和MA值与Fbg的Kappa值分别为0. 13、0. 25、0. 3571,卡方检验结果分别为X^2=594. 58 (P <0. 05)、X^2=174. 99 (P <0. 05)、X^2=396. 20(P <0. 05); R值的检测灵敏度高于PT、aPTT; Angle的检测灵敏度高于Fbg,而K值和MA的检测灵敏度均低于Fbg,但是Fbg的特异度较低。结论 TEG与常规凝血三项各参数间显著相关但一致性较弱,TEG可直观地根据CI值判断患者低凝或高凝状态,并能反映患者的凝血全过程。两种方法判断(1)患者出血和血栓状态的灵敏度均较低,但是TEG的检测灵敏度优于常规凝血三项试验。

Objective To compare the test results of thromboelastography( TEG) and routine coagulation tests( PT,aPTT,Fbg),then to investigate the correlation and consistency of the two methods,and to evaluate the value of the two methods in determining the blood coagulation of patients. Methods The results of TEG and routine coagulation tests of 3 081 patients in Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology and Zhongshan Hospital of Hubei Province from January to October 2016 were perfoemed and analyzed retrospectively for their correlation,Kappa identity test analysis and McNemar square test,and the diagnostic sensitivity and specificity of both methods in determining the blood coagulation of patients were evaluated. Results The R time of TEG and PT,R and aPTT both showed a linear dependence( P < 0. 001). The relationship between K,Angle,MA of TEG and Fbg all showed a linear dependence( P < 0. 001). The Kappa values of the R time of TEG with PT and aPTT in bleeding patients were0. 1 594 and 0. 1 768,respectively. The McNemar square test values of the R time of thromboelastography with PT and aPTT in bleeding patients were 0. 64( P > 0. 05) and 21. 36( P < 0. 05),respectively. The Kappa values of the K,Angle,MA of thromboelastography with FIB in bleeding patients were 0. 1 476,0. 1 081 and0. 3 712,respectively. The McNemar square test values of the K,Angle,MA of TEG with Fbg in bleeding patients all had statistical significance( P < 0. 05),with a value of 38. 06,130. 15 and 40. 09,respectively. The sensitivity and specificity of R was better than PT and aPTT in bleeding patients. The sensitivity and specificity of K,Angle and MA of TEG was better than Fbg. The Kappa values of the R time of TEG with PT and aPTT in thromboplastic patients were 0 and 0. 0 678. The McNemar square test values of the R time of TEG with PT and aPTT in thromboplastic patients were 228( P < 0. 05) and 106. 85( P < 0. 05). The Kappa values of the K,Angle,MA of TEG with Fbg in thromboplastic patients were 0. 13,0. 25 and 0. 3 571,respectively. The McNemar square test values of the K,Angle,MA of thromboelastography with Fbg in thromboplastic patients all had statistical significance( P < 0. 05),with X^2= 594. 58,X^2= 174. 99,X^2= 396. 20,respectively. The sensitivity of R was higher than PT,aPTT in thromboplastic patients,but the specificity of R,PT,aPTT only has little difference. The sensitivity of Angle was higher than Fbg,and the sensitivity of K and MA was both worse than Fbg. But,the specificity of Fbg was bad. Conclusion There was a significant correlation between some TEG parameters and routine coagulation tests,but the consistency was weak. The TEG could directly estimate the blood coagulation state of patients according to CI and reflect the whole process of the blood coagulation. The diagnostic sensitivity of two methods in the patients with bleeding or thrombus was low,but the diagnostic sensitivity of TEG was better than routine coagulation tests.