血栓弹力图检测对慢加急性肝衰竭患者凝血功能及预后评估的价值

Value of thrombelastogram in evaluation of coagulation function and prognosis in patients with acute on chronic liver failure

目的:观察血栓弹力图(TEG)检测对慢加急性肝衰竭(ACLF)患者凝血功能及预后评估的价值。方法:选取100例ACLF患者作为研究对象,患者均行TEG检测,同时进行血常规及凝血功能检测,并进行为期3个月的随访,记录患者消化道出血情况及生存情况,分析TEG检测参数单一和联合评估ACLF患者凝血功能及预后的价值。结果:100例患者中,消化道出血25例,未出血75例;死亡41例,生存59例;出血患者凝血因子活性(R)、凝血酶原时间(PT)和国际标准化比值(INR)均明显高于未出血患者,差异有统计学意义(P<0.05);死亡患者的血小板(PLT)水平、纤维蛋白原(FIB)水平、凝固夹角(α角)、最大血块强度(MA)值均明显低于生存患者,总胆红素(TBIL)水平、血氨(BA)水平、血乳酸(BLa)水平、血肌酐(Scr)水平、R值、纤维蛋白原功能(K)值、PT水平和INR均明显高于生存患者。TEG参数中的R值与TBIL、BLa水平及PT、INR呈正相关(P<0.05);K值与BA、PLT、FIB水平呈负相关(P<0.05);α角与PLT、FIB水平呈正相关(P<0.05),与BLa水平呈负相关(P<0.05);MA值与BLa、PLT、FIB水平呈正相关(P<0.05)。TEG四个参数联合评估的曲线下面积(AUC)明显高于R值、K值、α角、MA值单一项评估,对应的灵敏度、特异度分别为73.47%、92.16%。结论:TEG检测可作为ACLF患者凝血功能与预后评估的指标。

Objective:To explore Value of thrombelastogram(TEG)in evaluation of coagulation function and prognosis in patients with acute on chronic liver failure(ACLF).Methods:100 ACLF patients were selected as the research objects.All patients underwent TEG testing,blood routine examination and coagulation function test.They were followed up for 3 months.The patients’gastrointestinal bleeding and survival conditions were recorded.Then,the values of single TEG parameter and TEG combined parameters in evaluation of coagulation function and prognosis were analyzed.Results:Among the 100 patients,25 had gastrointestinal bleeding and 75 had no bleeding;41 died and 59 survived.The coagulation factor activity(R),prothrombin time(PT)and international normalized ratio(INR)of the patients with bleeding were significantly higher than those of the patients without bleeding,and the differences were statistically significant(P<0.05).The platelet(PLT)level,fibrinogen(FIB)level,coagulation angle(αangle),and maximum clotting strength(MA)values of the dead patients were significantly lower than those of the surviving patients;however,the total bilirubin(TBIL)level,blood ammonia(BA)level,blood lactate(BLa)level,blood creatinine(Scr)level,R value,fibrinogen function(K)value,PT level and INR were significantly higher than those of the surviving patients.The R value in the TEG parameters was positively correlated with the TBIL and BLa levels as well as the PT and INR(P<0.05);the K value was negatively correlated with the BA,PLT,and FIB levels(P<0.05);theαangle was positively correlated with the PLT and FIB levels(P<0.05),and negatively correlated with the BLa level(P<0.05);and the MA value was positively correlated with the BLa,PLT,FIB levels(P<0.05).The area under curve(AUC)of the four parameters of TEG was significantly higher than the single R value,K value,αangle and MA value evaluation,and the corresponding sensitivity and specificity were 73.47%and 92.16%,respectively.Conclusions:TEG detection can be used as an indicator for evaluating the coagulation function and prognosis of the ACLF patients.