血栓弹力图和常规凝血试验评估结肠癌和结肠息肉患者凝血状态的临床价值

Clinical value of thromboelastography and conventional coagulation tests in evaluating coagulation status of colon cancer and colon polyps

目的了解结肠癌和结肠息肉患者凝血功能的变化规律,探讨血栓弹力图(TEG)和常规凝血试验(CCT)在评价结肠癌和结肠息肉患者凝血功能和预测血栓发生中的临床应用价值。方法选取2018年5月—2019年5月在同济大学附属第十人民医院就诊的128例结肠癌患者(结肠癌组)和147例结肠息肉患者(结肠息肉组),以同期健康体检者60名作为正常对照组。对所有研究对象进行TEG[指标包括凝血反应时间(R)、凝血形成时间(K)、血细胞凝块形成速率(α角)、血栓最大振幅(MA)和凝血综合指数(CI)]、CCT[指标包括凝血酶原时间(PT)、纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(DD)]和血小板(PLT)计数检测,观察各组凝血相关指标的差异。采用受试者工作特征(ROC)曲线评价各项指标评估结肠癌患者和结肠息肉患者血液高凝状态的性能。结果有67.19%的结肠癌患者存在高凝状态,有34.69%的结肠息肉患者存在凝血异常。与正常对照组比较,结肠癌组R、K、PT、APTT、TT、PLT计数明显降低(P<0.01),α角、MA、CI、Fib、DD明显升高(P<0.01)。与结肠息肉组比较,结肠癌组R、K、APTT、TT、PLT计数明显降低(P<0.05),α角、CI、Fib、DD明显升高(P<0.05)。与正常对照组比较,结肠息肉组MA和CI明显升高(P<0.05)。ROC曲线分析结果显示,CCT对结肠癌患者血液高凝状态的评估价值较好,曲线下面积为0.863,敏感性为68.8%,特异性为92.3%;TEG评价结肠息肉患者血液高凝状态的价值较好,曲线下面积为0.726,敏感性为70.3%,特异性为61.5%。结论TEG和CCT在凝血功能评估中可相互补充,不可相互取代,在结肠癌、结肠息肉患者凝血状态监测中均具有重要的临床意义。

Objective To understand the pattern of coagulation function change in colon cancer patients and colon polyp patients,and to investigate the clinical application value of thromboelastography(TEG)and conventional coagulation tests(CCT)in evaluating coagulation function and predicting thrombosis in colon cancer patients.Methods Totally,128 patients with colon cancer,147 patients with colon polyps in Shanghai Tenth People's Hospital of Tongji University from May 2018 to May 2019 were enrolled.A total of 60 patients with healthy subjects were enrolled as control group.The determinations of TEG[coagulation reaction time(R),coagulation formation time(K),alpha angle(α-Angle),maximum amplitude(MA)and coagulation index(CI)],CCT[prothrombin time(PT),fibrinogen(Fib),activated partial thromboplastin time(APTT),thrombin time(TT)and D-dimer(DD)]and platelet(PLT)count were performed,and the differences between the 2 groups were observed.Receiver operating characteristic(ROC)curve was used to evaluate the performance of each indicator for blood hypercoagulable state in colon cancer and colon polyp patients.Results The 67.19%of patients with colon cancer and 34.69%of patients with colon polyps had a blood hypercoagulable state.Compared with control group,R,K,PT,APTT,TT and PLT count were decreased(P<0.01),andα-Angle,MA,CI,Fib and DD were increased in colon cancer group(P<0.01).Compared with colon polyp group,R,K,APTT,TT and PLT count in colon cancer group were decreased(P<0.05),andα-Angle,CI,Fib and DD were increased(P<0.05).MA and CI were increased in colon polyp group compared with control group(P<0.05).The evaluation performance for blood hypercoagulable state in colon cancer group was optimal with CCT,with an area under curve of 0.863,a sensitivity of 68.8%and a specificity of 92.3%.That for blood hypercoagulable state in colon polyp group was optimal with TEG,with an area under curve of 0.726,a sensitivity of 70.3%and a specificity of 61.5%.Conclusions TEG and CCT are complementary in the evaluation of coagulation function and can not be replaced by each other,which play roles in clinic.