血栓弹力图指标与DIC的相关性及其诊断价值分析

Correlation between TEG and DIC and its diagnostic value

目的探讨血栓弹力图(TEG)指标与弥散性血管内凝血(DIC)的相关性和及其对DIC的诊断价值。方法选取2017年3月—2018年11月首都医科大学附属北京天坛医院重症监护室发生DIC患者36例作为研究组,无DIC发生患者60例作为对照组。对所有研究对象进行常规凝血指标检测与TEG指标检测,对比研究组中死亡患者与非死亡患者TEG指标。采用受试者工作特征(ROC)曲线比较常规凝血指标及TEG指标诊断DIC的敏感性与特异性。采用单因素Logistic分析判断各指标对DIC诊断的影响。结果研究组TEG指标中凝血反应时间(R)、凝血形成时间(K)均显著高于对照组(P<0.05),凝血形成速率(α)、凝血最终强度(MA)及凝血综合指数(CI)均显著低于对照组(P<0.05)。与DIC生存患者相比,DIC死亡患者R、K均显著延长(P<0.05),α、MA及CI均显著降低(P<0.05)。DIC死亡患者各项常规凝血指标与DIC生存患者比较,差异均有统计学意义(P<0.05)。常规凝血指标的敏感性与特异性均低于TEG各指标。单因素Logistic分析结果显示,R、K、α、MA、CI、国际标准化比率(INR)、血浆纤维蛋白原(Fib)均为DIC发生的危险因素(P<0.05)。结论TEG指标与常规凝血指标均可用于预测DIC发生的风险。TEG指标诊断DCI的特异性更高,对DIC早期诊断及预后预防均具有重要指导意义。

Objective To investigate the correlation between thrombelastogram(TEG)and disseminated intravascular coagulation(DIC)and its diagnostic value.Methods From March 2017 to November 2018,96 patients with suspected DIC in intensive care unit of Beijing Tiantan Hospital of Capital Medical University were enrolled.Totally,36 patients with DIC were enrolled as study group,and 60 patients without DIC were enrolled as control group.Conventional coagulation indexes and TEG indexes were determined,and TEG indexes of dead patients and non-dead patients were compared.The sensitivities and specificities of conventional coagulation indexes and TEG indexes in the diagnosis of DIC were evaluated by receiver operating characteristic(ROC)curve.The influence of TEG on the diagnosis of DIC was analyzed with single factor Logistic analysis.Results The reaction(R)time and clot formation(K)time of TEG in study group were longer than those in control group(P<0.05),and the angle alpha(α),maximum amplitude(MA)and coagulation index(CI)in study group were smaller than those in control group(P<0.05).In the study group,the R time and K time of dead DIC patients were prolonged(P<0.05),theαangle,MA and CI were reduced compared with non-dead DIC patients.In the study group,there was statistical significance in the conventional coagulation indexes between dead and non-dead DIC patients(P<0.05).The sensitivities and specificities of conventional coagulation indexes were lower than those of TEG indexes.In single factor Logistic analysis,R time,K time,αangle,MA,CI,international normalized ratio(INR)and fibrinogen(Fib)were risk factors(P<0.05).Conclusions TEG indexes and conventional coagulation indexes can be used in predicting the risk of DIC,and TEG indexes have higher diagnostic specificities,which have guiding significance for the early diagnosis and prognosis prevention of DIC.