血栓弹力图对单纯颅脑损伤急性期凝血功能障碍的诊断价值

Diagnostic value of thromboelastography for coagulation dysfunction in acute stage of simple brain injury

目的分析血栓弹力图(TEG)对单纯颅脑损伤急性期凝血功能障碍的诊断价值。方法回顾性分析空军军医大学唐都医院神经外科2017年1月至2018年1月收治的51例单纯颅脑损伤急性期患者的临床资料。根据常规凝血指标检测结果把患者分为凝血功能障碍组(24例)与凝血功能正常组(27例),比较两组的临床资料,分析TEG各参数与常规凝血指标间的相关性,采用受试者工作特征曲线(ROC曲线)分析TEG各参数对单纯颅脑损伤急性期凝血功能障碍的诊断效能。结果两组受伤原因、血红蛋白、血小板计数、凝血酶原时间、凝血酶原活动度、国际标准化比值、纤维蛋白原(FIB)、活化部分凝血活酶时间、凝血酶时间、反应时间、凝固时间(K)、凝固角(α角)、最大振幅(MA)水平比较,差异均有统计学意义(P<0.05)。FIB与K、MA、α角的相关性强(r=-0.536,P<0.001;r=0.615,P<0.001;r=0.590,P<0.001)。ROC曲线分析结果显示,K、α角、MA诊断单纯颅脑损伤急性期凝血功能障碍的曲线下面积分别为0.806、0.814、0.846。结论TEG各参数的检测结果与常规凝血指标的检测结果存在一定的相关性,且K、α角、MA对单纯颅脑损伤急性期凝血功能障碍具有一定的诊断价值,可用于临床辅助诊断。

Objective To analyze the diagnostic value of thromboelastography(TEG)for coagulation dysfunction in acute stage of simple brain injury.Methods The clinical data of 51 patients with acute stage of simple brain injury treated from January 2017 to January 2018 in the Department of Neurosurgery of Tangdu Hospital,Air Force Military Medical University were analyzed retrospectively.The patients were divided into coagulation dysfunction group(24 cases)and normal coagulation group(27 cases)according to the results of routine coagulation indexes.The clinical data of the two groups were compared,and the correlation between TEG parameters and routine coagulation indexes were analyzed.Receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic efficacy of TEG parameters for coagulation dysfunction in acute stage of simple brain injury.Results There were statistically significant differences in injury cause,hemoglobin,platelet count,prothrombin time,prothrombin activity,international normalized ratio,fibrinogen(FIB),activated partial thromboplastin time,thrombin time,reaction time,coagulation time(K),coagulation angle(αangle)and maximum amplitude(MA)between the two groups(P<0.05).FIB had strong correlation with K,MA andαangle(r=-0.536,P<0.001;r=0.615,P<0.001;r=0.590,P<0.001).ROC curve analysis showed that the area under the curve of K,αangle and MA in the diagnosis of coagulation dysfunction in acute stage of simple brain injury was 0.806,0.814 and 0.846 respectively.Conclusion There is a certain correlation between the detection results of TEG parameters and the routine coagulation indexes,and K,αangle and MA have certain diagnostic value for coagulation dysfunction in acute stage of simple brain injury,which can be used for clinical auxiliary diagnosis.