血栓弹力图检测对于血液恶性肿瘤患者体内凝血状态的评估作用

Effect of Thromboelastography Test on the Evaluation of Blood Coagulation Status in Patients with Hematological Malignancies

目的探讨血栓弹力图检测(TEG)对于血液恶性肿瘤(HM)患者体内凝血状态的评估作用。方法选取2018年1月至2020年12月郑州大学附属郑州中心医院收治的84例HM患者作为HM组,同时选取40例健康体检者作为健康对照组,抽取HM患者和健康对照组患者晨起空腹静脉血送检进行凝血功能检查,检测指标包括血小板计数(PLT)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)。同期抽取两组患者静脉血,应用全血复钙法构建血栓弹力图,记录参数包括凝血反应时间(R)、凝血形成时间(K)、凝固角(α角)、血栓最大强度(MA)、LY30、凝血综合指数(CI)。比较HM组患者和健康对照组患者各项凝血指标和TEG参数并对凝血指标和TEG参数进行相关性分析。结果HM组PLT、R、MA、LY30、CI低于健康对照组,PT、APTT、K值高于健康对照组,差异有统计学意义(P<0.05)。HM组中,急性白血病48例、慢性粒细胞性白血病4例、非霍奇金氏淋巴瘤10例、多发性骨髓瘤22例。相较于健康对照组,急性白血病组患者R值、α角、MA、LY30、CI更低,而K值高于健康对照组;慢性粒细胞性白血病组患者R值、MA、LY30、CI更低,而K值高于健康对照组;非霍奇金氏淋巴瘤组患者R值、K值、LY30更低(P<0.05),而α角、CI高于健康对照组;多发性骨髓瘤组患者R值、K值、LY30更低,而α角高于健康对照组,差异有统计学意义(P<0.05)。HM患者血栓弹力图各项参数与PT的相关性中,K值与PT呈正相关(r=0.726,P<0.05),α角、MA、LY30、CI与PT呈负相关(r=-0.728、-0.571、-0.608、-0.719,P<0.05);HM患者血栓弹力图各项参数与PLT的相关性中,MA、LY30、CI与PLT呈正相关(r=0.383、0.305、0.294,P<0.05);HM患者血栓弹力图各项参数与APTT的相关性中,K值与APTT呈正相关(r=0.228,P<0.05)。结论HM患者存在低凝状态,血栓弹力图可评估患者凝血情况,作为预测HM患者出血风险的重要依据。

Objective To explore the role of thromboelastography(TEG)in evaluating blood coagulation status in patients with hematological malignancies(HM).Methods A tatol of 84 patients with HM who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2018 to December 2020 were selected.At the same time,40 healthy subjects who were examined in the physical examination center of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as a healthy control group.Patients with HM and healthy controls were sampled.In the morning,fasting venous blood of patients in the group were sent for coagulation function examination.The detection indicators included platelet count(PLT),prothrombin time(PT)and activated partial thromboplastin time(APTT).The venous blood of two groups of patients were drawn at the same time,and the whole blood recalcification method was used to construct a thromboelastogram.The recording parameters include coagulation reaction time(R),coagulation time(K),setting angle(αangle),maximum thrombus strength(MA),LY30,Coagulation Index(CI).The coagulation indexes and TEG parameters of patients with HM and healthy control patients were compared,and the correlation between coagulation indexes and TEG parameters were analyzed.Results The PLT,R,MA,LY30 and CI of the HM group were lower than those of the healthy control group(P<0.05),and the PT,APTT and K of the HM group were higher than those of the healthy control group(P<0.05).Among 84 patients with HM,there were 48 cases of acute leukemia,4 cases of chronic myelogenous leukemia,10 cases of non-Hodgkin’s lymphoma,and 22 cases of multiple myeloma.Compared with the healthy control group,the R value,angle,MA,LY30 and CI of the acute leukemia group were significantly lower(P<0.05),while the K value was significantly higher than the healthy control group(P<0.05).The chronic myeloid leukemia group the R value,MA,LY30,and CI of the patients were lower(P<0.05),and the K value was higher than that of the healthy control group(P<0.05).The R value,K value,and LY30 of the patients in the non-Hodgkin’s lymphoma group were higher Low(P<0.05),while the angle and CI were significantly higher than those in the healthy control group(P<0.05);the R value,K value,and LY30 in the multiple myeloma group were significantly lower(P<0.05),while theαangle was higher than that in the healthy control group Group(P<0.05).Among the correlations between various parameters of thromboelastogram and PT in patients with HM,K value was positively correlated with PT(r=0.726,P<0.05),andαangle,MA,LY30,CI and PT were negative correlation with PT(r=-0.728,-0.571,-0.608,-0.719,P<0.05).In the correlation between various parameters of thromboelastogram and PLT in patients with hematological malignancies,MA,LY30,and CI were positively correlated with PLT(r=0.383,0.305,0.294,P<0.05).In the correlation between various parameters of thromboelastogram and APTT in patients with hematological malignancies,the K value was positively correlated with APTT(r=0.228,P<0.05).Conclusion Patients with HM have a hypocoagulable state,and thromboelastography can assess the coagulation status of patients,as an important basis for predicting the bleeding risk of patients with hematological malignancies.