血栓弹力图对热射病患者的凝血状态评估及预后价值分析

Coagulation status and prognostic value of thromboelastography in heat stroke

目的分析血栓弹力图(thromboelastography,TEG)在热射病(heat stroke,HS)患者凝血状态评估中的应用价值,并探讨其对HS患者短期死亡的预测价值。方法回顾性分析了2015年1月一2019年12月就诊的HS患者。根据其28 d结局将患者分为病死组及存活组。分析病死组及存活组的临床特征差异,应用TEG评估2组间凝血状态差异,探讨TEG对HS患者28 d死亡有预测价值的参数及与死亡有关的危险因素。结果存活组与病死组在性别、年龄、BMI,基础病、最高核心体温等方面差异无统计学意义(P>0.05)。39位HS患者中,TEG显示凝血状态异常者有17例(43.59%)。病死组低凝状态(83.33%)比例高于存活组(30.30%)(P=0.046)。病死组HS R值延长(P=0.009)。与存活组比较,病死组K值偏高,α角及CI偏低,但2组间差异无统计学意义(P>0.05)。R值预测HS 28 d死亡的受试者工作特征曲线下面积为0.849(95%CI为0.694〜0.992,P=0.007),诊断界值为6.75 min,对应灵敏度、特异度和约登指数分别83.30%、87.50%、0.71。α角和CI的ROC曲线下面积分别是0.227和0.221,对死亡无预测价值。多因素Logistic回归分析发现低凝状态R值、α角和CI均不是HS患者28 d死亡的独立危险因素(P>0.05)。结论HS患者常合并凝血功能异常。重症者多表现为低凝状态。TEG检测可以反映HS严重程度,对短期死亡有一定的预测价值。

Objective To analyze the applicability of thromboelastography(TEG)in the evaluation of coagulation status in patients with heat stroke(HS),and to explore its ability to predict short-term death of HS patients.Methods The clinical data onpatients with HS treated between January 2015 and December 2019 was analyzed retrospectively.According to the 28-day outcome,these patients were divided into the survival group and non-survival group.The difference in clinical features between the two groups was analyzed.The difference in coagulation status between the two groups was determined by TEG,while the predictive parameters of TEG for 28-day death of HS patients and the risk factors for death were explored.Results There was no significant difference in gender,age,BMI,preexisting diseases or highest body temperatures between the two groups(P>0.05).Among the 39 HS patients,17(43.59%)showed abnormal coagulation.The incidence of hypocoagulation in the non-survival group(83.33%)was higher than that of the survival group(30.30%)(P=0.046).The R value of HS patients in the non-survival group was prolonged(P=0.009).Compared with the survival group,theαvalue of the non-survival group was higher,theαangle and CI were lower,but there was no significant difference between the two groups(P>0.05).The area under the receiver operating characteristic curve(ROC curve)for R value was 0.849(95%CI:0.694-0.992,P=0.007),and the diagnostic cut-off value was 6.75 min.The corresponding sensitivity,specificity and Youden index were 83.30%,87.50%and 0.71,respectively.The areas under the ROC curve ofαangle and CI were 0.227 and 0.221 respectively,which was of no predictive value for death.Logistic regression analysis showed that hypocoagulation,a angle and CI were not independent risk factors for 28-day death in HS patients.(P>0.05).Conclusion Patients with HS often have abnormal coagulation function.Most of the severe cases manifest hypocoagulation.TEG detection can reflect the severity of HS and can help predict short-term death to some extent.