血栓弹力图及常规凝血指标在急性胰腺炎病情评估中的价值

Value of thromboelastography combined with conventional coagulation parameters in the assessment of severity of acute pancreatitis

目的探讨血栓弹力图(TEG)及常规凝血指标在急性胰腺炎(AP)发病早期对病情严重程度评估的价值。方法纳入发病时间<24 h的AP患者65例,根据病情将其分为3组:轻症急性胰腺炎(MAP)组25例、中重症急性胰腺炎(MSAP)组23例、重症急性胰腺炎(SAP)组17例。随访2个月,根据随访期内患者是否存活分为存活组54例、死亡组11例。患者入院后检测TEG、常规凝血功能、血常规、血生化及动脉血气分析,行急性生理与慢性健康评分Ⅱ(APACHEⅡ)评估,并进行分组比较分析。结果与MAP组及MSAP组比较,SAP组PLT计数下降,D-D、FIB升高,APTT及PT明显延长(P<0.05);与MAP组比较,MSAP组PLT计数下降,FIB升高(P<0.05)。与存活组比较,死亡组患者的PLT计数下降,D-D、FIB升高,APTT及PT明显延长(P<0.05)。与MAP组及MSAP组比较,SAP组R值、K值均减小,MA值、α角度均增大(P<0.05);与MAP组比较,MSAP组R值、K值均减小,MA值、α角度均增大(P均<0.05)。与存活组比较,死亡组患者的R值、K值均减小,MA值、α角度均增大(P<0.05)。相关性分析结果显示,AP患者的R值、MA值、α角、K值与PLT、D-D、APTT、PT及FIB均具有相关性(P<0.05)。APACHEⅡ评分与R值及K值呈负相关,与α角、MA值呈正相关(P<0.05)。结论AP患者的病情及预后与凝血系统功能紊乱程度密切相关,TEG指标与常规凝血指标具有明显相关性,有助于对AP患者病情的评估。

Objective To investigate the value of thromboelastography(TEG)and conventional coagulation parameters in the assessment of severity of disease in the early stage of acute pancreatitis(AP).Methods Sixty-five cases of AP patients whose onset time<24 h were included and divided into three groups,with 25 cases in mild acute pancreatitis(MAP)group,23 cases in moderate acute pancreatitis(MSAP)group and 17 cases in severe acute pancreatitis(SAP)group.After 2 months of follow-up,they were divided into survival group(54 cases)and death group(11 cases)according to whether the patients survived during the follow-up period.Patients were examined for TEG,routine coagulation,blood routine,blood biochemistry,arterial blood gas analysis and APACHEⅡafter admission.Indexes above were compared and analyzed.Results Compared with MAP group and MSAP group,PLT count decreased,D-D and FIB increased,APTT and PT prolonged in SAP group(P<0.05).Compared with MAP group,PLT count decreased and FIB increased in MSAP group(P<0.05).Compared with survival group,PLT count decreased,D-D and FIB increased,APTT and PT prolonged(P<0.05).Compared with MAP group and MSAP group,R value and K value of SAP group decreased,MA value andαangle increased(P<0.05).Compared with MAP group,R Value,K value in MSAP group decreased,MA value andαangle increased(P<0.05).Compared with survival group,the R and K values of the patients in death group decreased,while the MA andαangles increased(P<0.05).The correlation analysis results showed that,there were correlations between R value,MA value,αangle and PLT,D-D,APTT,PT,FIB in 65 patients(P<0.05).There was a negative correlation between APACHEⅡscore with R value and K value,and positive correlation withαangle and MA value(P<0.05).Conclusion The severity and prognosis of patients with AP are closely related to the degree of dysfunction of the coagulation system.The TEG index is significantly correlated with the conventional hemagglutination index and contributes to the assessment of the severity of AP patients.