血栓弹力图检测在评估肝癌患者凝血状态中的临床价值

Clinical value of thromboelastogram in evaluating coagulation fuction of patients with liver cancer

目的探讨血栓弹力图(TEG)在评估肝癌患者凝血状态中的应用价值。方法回顾性分析2017年8月~2020年9月在南阳市中心医院肝胆外科就诊的102例肝癌患者和48例肝血管瘤患者。收集患者的TEG检测指标(R值、K值、Angle值、MA值、CI值和G值)、常规凝血指标(Plt、PT、INR、APTT、FIB、TT)以及肝癌患者的基本临床资料。分析肝癌组和肝血管瘤组不同检测参数之间的差异性;分析TEG参数在不同肝癌患者亚组中的差异性,并采用Spearman秩相关分析肝癌患者TEG与常规凝血检测之间的相关性,并比较2种检测方法在判断肝癌患者凝血状态时敏感性的优劣。结果1)与肝血管瘤患者相比,肝癌患者Plt显著降低(166.6±108.824 vs 224.10±54.933,P<0.001),而PT值、INR值和APTT值则显著升高(分别为13.12±2.052 vs 11.421±0.884、1.156±0.191 vs 1.00±0.074、29.977±5.333 vs 26.954±5.269,均为P<0.05);肝癌患者的MA值和G值则低于肝血管瘤患者(分别为56.991±11.574 vs 60.069±5.094、7.667±4.682 vs 7.725±1.709,均为P<0.05);2)与初诊肝癌患者相比,复诊肝癌患者的Plt显著降低(125.78±79.673 vs 188.86±116.437,P<0.05),R值和K值显著升高(分别为7.594±2.601 vs 6.058±1.739、3.453±2.402 vs 2.438±1.990,均为P<0.05),而Angle值、MA值、CI值和G值则显著降低(分别为53.897±12.288 vs 61.495±9.949、53.556±11.407 vs 58.865±11.313、-3.494±4.253 vs-0.836±3.180、6.311±3.209 vs 8.406±5.191,均为P<0.05);3)除R值外,TEG其它参数在肝切除、经肝动脉栓塞化疗术和保守治疗之间有差异(P<0.05);4)肝癌患者的R值、K值与其Plt值之间呈负相关,而Angle值、MA值、CI值和G值与Plt值之间呈正相关(P<0.001);肝癌患者K值与其FIB值之间呈负相关,而Angle值、MA值、CI值、G值与FIB值之间呈正相关(P<0.001);肝癌患者R值和K值与其TT值之间呈正相关,而Angle值、CI值与其TT值之间呈负相关(P<0.05);5)血栓弹力图检测对低凝状态的检出率为18.63%(19/102),常规凝血指标对低凝状态的检出率为7.84%(8/102),检出率之间有差异(P<0.05)。结论与初诊相比,复诊肝癌患者处于相对低凝状态。利用TEG能够更灵敏地诊断出肝癌患者凝血状态的变化,及时采取措施有利于降低出血风险。

Objective To explore the value of thromboelastogram(TEG)in evaluating coagulation function of patients with liver cancer.Methods 102 patients with liver cancer and 48 with hepatic hemangioma from Department of Hepatobiliary Surgery,Nanyang Central Hospital from August 2017 to September 2020 were retrospectively analyzed.TEG indicators(R,K,Angle,MA,CI,and G value)and routine coagulation indicators(Plt,PT,INR,APTT,FIB,and TT)of those patients and basic clinical data of liver cancer patients were collected,and the difference of detection parameters between the liver cancer group and liver hemangioma group was compared;The difference of TEG parameters in liver cancer patient subgroups was compared,and the correlation between TEG and routine coagulation tests in liver cancer patients was analyzed using Spearman rank correlation analysis.The sensitivity of the two detection methods in detecting the coagulation status of patients with liver cancer was compared.Results 1)Compared with patients with hepatic hemangioma,Plts decreased significantly(166.6±108.824 vs 224.10±54.933,P<0.001),while PT,INR and APTT values increased significantly(13.12±2.052 vs 11.421±0.884,1.156±0.191 vs 1.00±0.074,29.977±5.333 vs 26.954±5.269,all P<0.05)in patients with liver cancer;MA and G values in patients with liver cancer were lower(56.991±11.574 vs 60.069±5.094,7.667±4.682 vs 7.725±1.709,P<0.05);2)Compared with newly diagnosed liver cancer patients,the Plt of re-diagnosed liver cancer patients decreased significantly(125.78±79.673 vs 188.86±116.437,P<0.05);the R and K value increased significantly(7.594±2.601 vs 6.058±1.739,3.453±2.402 vs 2.438±1.990,all P<0.05),while the Angle,MA,CI and G value decreased significantly(53.897±12.288 vs 61.495±9.949,53.556±11.407 vs 58.865±11.313,-3.494±4.253vs-0.836±3.180,6.311±3.209 vs 8.406±5.191,all P<0.05);3)There were significant differences in TEG parameters(R value excluded)between liver resection,transhepatic arterial chemoembolization and conservative treatment(P<0.05);4)The R,K value of patients with liver cancer were negatively correlated with the Plt value,while the Angle,MA,CI,and G value were positively correlated with Plt value(P<0.001);the K value was negatively correlated with the Fib value,while the Angle,MA,CI,G value were positively correlated with Fib value(P<0.001);the R and K value were positively correlated with TT value,while the Angle and CI were negatively correlated with TT value(P<0.05);5)The detection rate of hypocoagulability by TEG and routine coagulation testing was 18.63%(19/102)and 7.84%.Conclusion Compared with the newly diagnosed liver cancer patients,re-diagnosed liver cancer patients showed hypercoagulability.TEG can diagnose the coagulation abnormalties more sensitively,and help reduce the risk of bleeding.