血栓弹力图与凝血功能检测、血小板计数在恶性肿瘤患者中的相关性分析

Correlation analysis between thrombelastogram and coagulation test and platelet count in patients with malignant tumor

目的分析恶性肿瘤患者血栓弹力图(TEG)与凝血功能、血小板计数(PLT)之间的相关性。方法选择重庆市肿瘤研究所2016年11月至2017年3月同时检测了TEG与凝血功能、血常规的241例恶性肿瘤患者为研究对象,进行TEG参数与凝血功能指标、PLT相关回归分析。采用χ2检验比较TEG参数与凝血功能指标、PLT阳性率的差异;秩和检验比较肝癌、乳腺癌、胰腺癌的多个参数间的差异。结果恶性肿瘤患者的TEG参数中凝血反应时间(R)与活化部分凝血活酶时间(APTT)呈正相关,与凝血酶时间(TT)、D-二聚体(DD)、纤维蛋白(原)降解产物(FDPs)呈负相关;血细胞凝集块形成时间(K)与部分凝血活酶时间(APTT)、TT呈正相关,与纤维蛋白原(FIB)、PLT呈负相关;血细胞凝集块形成速率(α)与FIB、PLT呈正相关,与APTT、TT呈负相关;血凝块最大强度(MA)与FIB、PLT呈正相关,与TT呈负相关;凝血综合指数(CI)与FIB、PLT呈正相关,与APTT呈负相关(P<0.05)。其中FIB、PLT与MA的相关性最高(r=0.611、0.545)。并得到TEG各参数与凝血功能指标的一元线性回归方程。TEG检测阳性人数明显少于凝血功能检测阳性人数(P<0.05)。TEG与凝血功能参数在肝癌、乳腺癌和胰腺癌患者间有一定差异。结论 TEG与PLT常规凝血检测结果明显相关,检测有一致性,但整体来说吻合度一般,不能相互替代,并且不同癌症类型的TEG与凝血功能参数并不完全一致。

Objective To analyze the correlation between thrombelastography(TEG)and coagulation,platelet count(PLT)in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 241 cases with tumor who were performed TEG,coagulation and blood test in the same day in Chongqing Cancer Institute from November 2016 to March 2017.Linear correlation and regression were carried out to analyze relationship among the parameters.The number of patients with positive blood clotting,PLT and TEG parameters were counted,and theχ2 test was used to compare the difference between them.Using Mann-Whitney U test to compare the differences between multiple parameters of liver cancer,breast cancer,and pancreatic cancer.Results The R value of TEG parameters in patients with malignant tumor was positively correlated with APTT,negatively correlated with TT,DD and FDPs.K was positively correlated with APTT and TT,and negatively correlated with FIB and PLT.The relationship betweenαand FIB,PLT were positive,between APTT and TT were negative.MA was positively correlated with FIB and PLT,negatively correlated with TT,CI was positively correlated with FIB and PLT,and negatively correlated with APTT(P<0.05).The correlation between FIB,PLT and MA was the highest.And the linear regression equation of TEG parameters and coagulation indexes was obtained.The positive rate of TEG was lower than that of coagulation(P<0.05).Same certain differences of TEG and coagulation parameters were existed in liver cancer,breast cancer and pancreatic cancer patients.Conclusion TEG is significantly associated with PLT and conventional coagulation test,and the results of TEG and conventional coagulation test are consistent to a certain degree,but the overall agreement is generally not interchangeable.TEG might be play a complementary role with coagulation tests and platelet counts.And the TEG of different cancer types is not exactly the same as the coagulation parameters.