血栓弹力图和常规凝血实验在慢性肾脏病各期凝血及纤溶功能检测中的作用

The role of thromboelastography and conventional coagulation test in the detection of coagulation and fibrinolysis in different stages of chronic kidney disease

目的观察血栓弹力图(TEG)和常规凝血实验检测慢性肾脏病(CKD)各期凝血、纤维蛋白溶解(纤溶)功能的变化,为CKD的诊断、治疗和预后提供参考。方法用TEG和常规凝血实验法对2017年6月至2018年12月收治的170例CKD患者(CKD组)以及100例健康体检者(对照组)进行凝血、纤溶功能的分析;CKD组按照(K/DOQI)指南的分期标准分为5个亚组(CKD1~2期组28例,CKD3期组36例,CKD4期组31例,CKD5期未透析组43例,CKD5期透析组32例),通过对数据的整理、运算进行分析。结果对照组的TEG参数[凝血因子功能(R)、纤维蛋白原功能(K)、α角、血小板聚集功能(MA)]和常规凝血项目[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化率(INR)、纤维蛋白原(FIB)、凝血酶时间(TT)]与CKD组差异有统计学意义(P<0.05,P<0.01);在TEG检测结果中,纤溶功能参数(EPL,Ly30)的变化在CKD各亚组间无差异(P>0.05);在常规凝血实验检测结果中,CKD1~2期组纤溶功能参数的变化与CKD组中的其他亚组间差异有统计学意义(P<0.0125),余亚组间差异无统计学意义(P>0.0125);两种检测方法提示有纤溶功能亢进的累计人数占实验组的40.00%,共同显示纤溶功能亢进者占纤溶功能亢进总例数的14.71%;两种检测方法在纤溶功能检测中的差异较大,不存在一致性(Kappa值=0.054,P>0.05)。结论TEG和常规凝血实验两种检测方法在测定凝血、纤溶功能方面有互相补充的作用,从不同的角度反映机体的真实状态,可以高效、及时地为临床诊断、治疗提供依据。

Objective To observe the changes of coagulation and fibrinolysis in different stages of chronic kidney disease(CKD)by thromboelastography(TEG)and routine coagulation test,so as to provide reference for the diagnosis,treatment and prognosis of CKD.Methods The function of coagulation and fibrinolysis of 170 patients with CKD(CKD group)and 100 healthy people(control group)admitted from June 2017 to December 2018 were analyzed by TEG and conventional coagulation test.The CKD group was divided into 5 subgroups(28 cases in CKD1-2 stage group,36 cases in CKD3 stage group,31 cases in CKD4 stage group,43 cases in CKD5 stage non dialysis group and 32 cases in CKD5 stage dialysis group)according to the stage standard of K/DOQI guideline,the research results were obtained through data sorting and operation.Results There were significant differences in TEG parameters(R,K,α,MA)and routine coagulation items(PT,APTT,INR,FIB,TT)between the control group and the CKD group(P<0.05,P<0.01).In the test results of TEG,there was no difference in the changes of fibrinolytic function parameters(EPL,ly30)among the subgroups of the CKD group(P>0.05).In the results of routine coagulation test,there was a significant difference between the parameters of fibrinolysis in CKD1-2 group and other subgroups in the CKD group(P<0.0125),but no significant difference between the other subgroups(P>0.0125).The two methods indicated that the cumulative number of patients with hyperfibrinolysis accounted for 40.00%of the CKD group,and together showed that patients with hyperfibrinolysis accounted for 14.71%of the total cases of hyperfibrinolysis.The difference between the two methods in the detection of fibrinolysis was large,and there was no consistency(Kappa=0.054,P>0.05).Conclusions The TEG and conventional coagulation test are complementary to each other in the determination of coagulation and fibrinolysis function.They can reflect the real state of the body from different angles,and provide the basis for clinical diagnosis and treatment in a timely and efficient manner.