血栓弹力图联合凝血指标检测在慢性乙型肝炎患者中的应用研究

Significance of thromboelastography in patients with chronic hepatitis B at different clinical stages

目的:分析慢性乙型肝炎病毒(HBV)感染后不同临床阶段外周血血栓弹力图(TEG)、常规凝血指标检测的水平,探讨TEG与传统凝血指标检测在评估慢性肝病患者凝血功能方面的意义。方法:选取2019年9月~2020年2月慢性乙型肝炎患者115例,依照慢性肝病患者不同临床阶段的诊断标准分为四组:慢性乙型肝炎组42例(慢乙肝组),乙肝肝硬化组38例(肝硬化组),HBV相关肝衰竭组35例(肝衰竭组),筛选同期30例献血员为健康对照组;分别抽取研究对象外周血检测血常规、常规凝血全套、TEG参数,并进行比较。结果:(1)四组中慢乙肝组较对照组常规凝血指标及TEG参数的结果差异均无统计学意义(P>0.05)。(2)肝硬化、肝衰竭组患者外周血浆PT、APTT较对照组及慢乙肝组明显延长,INR值明显升高(P<0.001),而PTA、FIB、全血中PLT较对照组及慢乙肝组明显降低(P<0.001)。肝衰竭组与肝硬化患者组相比较外周血浆中的PT、APTT较肝硬化患者延长(P<0.001)、INR高于肝硬化患者(P<0.001);肝衰竭患者外周血浆中PTA、FIB、全血中PLT明显低于肝硬化患者(P<0.001)。(3)肝硬化、肝衰竭组患者外周全血R值、K值较对照组及慢乙肝组明显延长,CI值明显升高(P均<0.001),而α-角、MA较对照组及慢乙肝组明显减低(P<0.001)。肝衰竭组与肝硬化组相比较外周全血中的R值、K值较肝硬化患者延长(P<0.001)、CI值高于肝硬化患者(P<0.001);肝衰竭患者外周全血中α-角、MA明显低于肝硬化患者(P<0.001)。(4)R、K、PT、APTT、INR值评估肝衰竭组凝血功能的ROC曲线下面积分别为0.928、0.864、0.805、0.851、0.767(P<0.05)。R值及K值曲线下面积最大,且敏感度及特异度均高于常规凝血指标(P<0.05)。结论:TEG是评估慢性肝病患者凝血状态的一种综合、可靠指标,TEG联合检测常规凝血指标,对全面评估慢性肝病患者凝血功能的变化发挥重要作用。

Objective:To analyze the levels of peripheral thromboelasticity(TEG)and conventional coagulation indicators in different clinical stages after chronic hepatitis B virus(HBV)infection,and to explore the significance of TEG and traditional coagulation indicators in assessing coagulation function in patients with chronic liver disease.Methods:A total of 115 patients with chronic HBV infection were included in the study,including 42 patients with chronic hepatitis B(chronic hepatitis B group),38 patients with hepatitis B cirrhosis(cirrhosis group),and 35 patients with HBV-related liver failure(liver failure group).30 cases of healthy blood donors were selected as normal control group.The peripheral blood of the study subjects were collected for routine blood test,routine coagulation test,and TEG parameters,and compared.Results:(1)There were no significant differences in the results of conventional coagulation indicators and TEG parameters between the chronic hepatitis B group and the control group in the four groups(all P>0.05).2)Peripheral blood PT and APTT in patients with liver cirrhosis and liver failure were significantly longer than those in the control group and chronic hepatitis B group,and the INR values were significantly increased(P<0.00),while PTA,FIB,and PLT were significantly higher than those in the control group and chronic hepatitis B group Decrease(both P<0.00).Compared with patients with liver cirrhosis,PT and APTT in the liver failure group were longer than those in patients with cirrhosis(P<0.00),and INR was higher than those in patients with liver cirrhosis(P<0.00).PTA,FIB,PLT was significantly lower in patients with cirrhosis(P<0.00).3)Peripheral blood R and K values of patients with liver cirrhosis and liver failure were significantly longer than those of the control group and chronic hepatitis B group,and their CI values??were significantly increased(all P<0.00).The group was significantly reduced(all P<0.00).Compared with patients with liver cirrhosis,the R and K values??in liver failure group were longer than those in patients with liver cirrhosis(P<0.00),and CI values??were higher than those in patients with liver cirrhosis(P<0.00).Αin peripheral blood of patients with liver failure-Angle and MA were significantly lower than those in patients with cirrhosis(P<0.00).4)ROC curve analysis of R,K,PT,APTT,and INR values??to evaluate coagulation function in liver failure group,the results showed that 0.928,0.864,0.805,0.851,0.767(P<0.05).The area under the curve of R value and K value is the largest,and the sensitivity and specificity are higher than the conventional coagulation indicators(P<0.05).Conclusion:TEG is a comprehensive and reliable indicator for assessing the coagulation status of patients with chronic liver disease.TEG combined with conventional coagulation indicators plays an important role in comprehensively assessing the changes of coagulation function in patients with chronic liver disease.