血栓弹力图评价心力衰竭合并肺部感染患者凝血状态的价值研究

The Value of Thromboelastogram in the Evaluation of Coagulation State in Patients with Heart Failure and Pulmonary Infection

目的:探讨血栓弹力图(TEG)评价心力衰竭合并肺部感染患者凝血状态的价值。方法:选取来我院就诊的心力衰竭合并肺部感染患者70例作为研究组,同时选取非心力衰竭合并肺部感染并且无凝血相关疾病患者70例作为对照组。检测常规凝血相关指标、血小板指标以及TEG相关参数,分析TEG相关参数与常规凝血检查指标和血小板指标之间的相关性。以超声检查血栓是否发生为判断标准,对常规凝血检查指标、血小板指标和TEG参数分别进行回归分析,得到回归分析方程后绘制ROC曲线,比较TEG、常规凝血检查和血小板指标评价心力衰竭合并肺部感染患者凝血状态的效能。结果:研究组PT、TT和APTT、PLT水平较对照组显著降低,FIB和D-D较对照组显著升高,差异均具有统计学意义(P<0.05)。研究组中R值、K值较对照组显著下调,而α角和MA值较对照组显著上调,差异具有统计学意义(P<0.05)。R值与PT、TT以及APTT呈正相关(P<0.05);K值与FIB呈负相关,与APTT、PLT呈正相关(P<0.05);α角与FIB、D-D呈正相关,与PLT呈负相关(P<0.05);MA值与PT、PLT呈负相关,与FIB呈正相关(P<0.05)。ROC曲线显示,APTT、D-D、PLT诊断血栓的曲线下面积、特异度和灵敏度均小于TEG。结论:相比于传统常规凝血检查和血小板检查,TEG可以更加全面反映心力衰竭合并肺部感染患者的凝血状态,快速准确地判断心力衰竭合并肺部感染患者是否发生血栓。

Objective:To investigate the value of thromboelastogram(TEG)in evaluating coagulationstate in patients with heart failure and pulmonary infection.Methods:70 patients with heart failureand pulmonary infection who came to our hospital for treatment were selected as the study group,70 patients without heart failure complicated with pulmonary infection and coagulation related diseases were selected as the control group at the same time.Through the detection of conventional coagulation related indicators,platelet indicators and TEG related parameters,the correlation between TEG related parameters and conventional coagulation test indexes and platelet indexes was analyzed.With ultrasound examination for whether thrombus occurs or not as the judgment criterion,regression analysis was conducted on conventional coagulation test indicators,platelet index and TEG parameters respectively,the ROC curve was drawn after the regression equation was obtained,the TEG,routine coagulation test and platelet index were used to evaluate the efficacy of coagulation state inpatientswith heart failure and pulmonary infection were compared.Results:The levels of PT,TT,APTT and PLT in the study group were significantly lower than those in the control group,while the levels FIB and D-D were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The R and K values in the study group were significantly lower than those in the control group,theαangle and Ma value were significantly higher than those of the control group,the difference was statistically significant(P<0.05).R value was positively correlated with PT,TT and APTT(P<0.05);K value was negatively correlated with FIB,and positively correlated with APTT and PLT(P<0.05);αangle was positively correlated with FIB and D-D,and negatively correlated with PLT(P<0.05);MA value was negatively correlated with PT and PLT,and positively correlated with FIB(P<0.05).ROC curve showed that,the area under the curve,specificity and sensitivity of APTT,D-D and PLT in the diagnosis of thrombosis were lower than those of TEG.Conclusion:Compared with conventional coagulation test and platelet test,TEG can more comprehensively reflect the coagulation state of patients with heart failure and pulmonary infection,and quickly and accurately judge whether thrombosis occurs in patients with heart failure and pulmonary infection.