血栓弹力图评估肾肿瘤患者术前凝血状态的临床价值研究

Study of thrombelastogram in preoperative patients with renal tumor to evaluate coagulation status

目的采用血栓弹力图(TEC)和常规凝血功能检测来评估肾肿瘤患者术前的凝血功能状态,评估肾肿瘤患者术前凝Ⅰ血状态过程中TEG的临床应用价值,探讨TEC与凝血五项指标的相关性。方法选取2016年1月至2019年3月在本院行肾占位性病变手术的患者142例,并根据术后病理结果将患者分为肾癌组(97例)与肾良性疾病组(45例)。分别用TEG和常规凝血检测评估两组患者术前的凝血功能状态及两种凝血方法的临床价值。比较肾癌组患者的不同类型和不同病理分期的TEG参数。比较肾癌组患者的TEG参数与常规凝血功能参数的相关性。结果与肾良性疾病组比较,肾癌组患者TEG的R值、K值缩短(P<0.01),Angle角、MA和CI值增宽(P<0.01)。常规凝血功能参数方面:与肾良性疾病组比较,肾癌组的凝血酶原时间(PT)、纤维蛋白原(FⅠB)升高(P<0.01),国际化标准比值(INR).D-二聚体(DD)值上升(P<0.05),凝血酶原活动度(PTA)值下降(P<0.05),但两组的活化酶部分凝血酶时间(APTT)凝血酶时间(TT)指标比较,差异均无统计学意义(P>0.05)。两类肾癌患者的各项TEG参数比较,差异无统计学意义(P>0.05)。肾癌组ⅠⅡ.Ⅱ期患者之间的TEG各项参数比较,差异无统计学意义(P>0.05);肾癌N期患者的K值缩短(P<0.05),Angle角增宽(P<0.05);肾癌ⅠV期患者的MA值和CI值较Ⅰ.Ⅱ、Ⅱ期升高(P<0.05);与无淋巴结转移的肾癌患者的TEG参数比较,有淋巴结转移肾癌患者的K值缩短(P<0.05),Angle角MA和CⅠ值增宽(P<0.05);TEG参数的R值与APTT呈正相关(r=0.445,P<0.01);K值与PTA星正相关(r=0.206,P<0.05),与PT.FIB.DD呈负相关(r=-0.221.-0.485.-0.208,P<0.05);Angle角与FIB呈正相关(r=0.389,P<0.01),与APTT呈负相关(r=-0.257,P<0.05);MA值与FIB、DD呈正相关(r=0.642.0.279,P<0.05);CI值与PT.FIB和DD呈正相关(r=0.205.0.536.0.288,P<0.05),与APTT呈负相关(r=0.278,P<0.01)。结论肾肿瘤患者术前血液易处于高凝状态,而且高凝状态与晚期病情呈正相关。用TEG来评估肾癌患者术前的凝血状态更准确,与常规凝血实验检测具有互补作用。

Objective To estimate preoperative coagulation status in patients with renal cancer and explore the elinical value of thrombelastogram(TEG)by application of TEC and routine coagula-tion tests.To study the correlation of major indicators between TEC and coagulation function.Meth-ods A total of 142 patients who experienced renal surgery in our hospital from January 2016 to March 2019 were selected.First,patients were divided into a kidney cancer group(97 cases)and a renal benign disease group(45 cases)according to postoperative pathological results.The difference of co-agulaion function in preoperative period between two groups of patients was evaluated by TEG and con-ventional coagulation test,and the clinical value of them was assessed.Second,the kidney cancer group was analyzed separately to compare the correlation between TEG and routine blood coagulation parameters in patients with renal cell carcinoma,to find the relationship between TEG parameters of different pathological types and different pathological stages of renal cell carcinoma.Results Com-pared with the benign renal disease group,R and K value of TEG in renal cell carcinoma group were obviously shorter(P<0.01),and Angle,MA,and CI values were distinetly wider(P<0.01).PT and FIB values were significantly increased in routine coagulation(P<0.01).PTA values were de-creased(P<0.05).INR and DD values were inereased(P<0.05).The differences in APTT and TT values were not statistically significant(P>0.05).Compared with stage I,stage II,and stage IlI,there was a statistically signifcant difference in TEG parameters in stage IV kidney cancer(P<0.05).Compared with patients with lymph node metastasis and non-lymphatic metastasis,R,K,An-gle and CI value in TEG parameters were staistically signifcant(P<0.05).There was a correlation between certain parameters of TEG and conventional coagulation parameters in k idney cancer patients.Conclusions Preoperative blood of patients with renal cancer tends to be in a state of high blood c0-agulatin,and bypercoagulabilty is positively related 1o late-stage disease.TEC is more accurate in assessing the preoperative coagulation status of kidney cancer patients and complementary to routine co-agulation tests.