摘要
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.
作者
杨敬端
YANG Jingduan(The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000 He'nan,China)
出处
《中国民康医学》
2020年第18期92-95,共4页
Medical Journal of Chinese People’s Health
关键词
血栓弹力图
慢加急性肝衰竭
血常规
凝血功能
预后评估
Thrombelastogram
Acute on chronic liver failure
Blood routine
Coagulation function
Prognostic evaluation