关于建立本地区人群血栓弹力图参数参考范围必要性的探讨

A Discussion on the Necessity of Establishing the Reference Range ofThromboelastography Parameters in Local Population

目的探讨建立本地区人群血栓弹力图(TEG)参考范围的必要性,分析TEG检测的影响因素。方法依据美国临床和实验室标准化协会(CLSI)C28-A3的文件规范,对本地区202名健康志愿者进行TEG、生化和血常规检测,根据厂家参考范围,分析样本参数(R、K、α-Angle、MA)的特异性,根据生化及血常规参数结果进行亚组分析,探讨TEG检测的影响因素。结果202名志愿者TEG参数有22.8%(46/202)至少有1项在厂家参考范围之外,特异性为77.2%,与厂家设定的95%准确率存在显著差异。分析生化和血常规结果并分为正常组、PLT组、WBC组、GLU组、TG组和HCT组,结果发现:与正常组相比,参数K、α-Angle和MA在PLT组和WBC组的差异具有统计学意义(P<0.05),在GLU组、TG组和HCT组差异无统计学意义(P>0.05)。参数R是造成TEG参数整体特异性较低的主要原因,正常组与5个异常组间差异无统计学意义(P>0.05),不受上述参数的影响。参数R在不同性别、不同年龄间差异无统计学意义(P>0.05)。结论本地区人群只有参数R须通过多中心共同建立参考范围。白细胞和血小板对TEG参数K、α-Angle和MA值的检测有影响。

Objective To explore the necessity of establishing the reference range of TEG in local population and to analyze the influencing factors of TEG detection.Methods According to the document specification C28-A3 of the American Institute for Clinical and Laboratory Standardization(CLSI),TEG,biochemical and blood routine tests were performed on 202 healthy volunteers in this area.The specificity of sample parameters(R,K,α-Angle,MA)was analyzed according to the manufacturer’s reference range.Subgroup analysis was then conducted according to the results of biochemical and blood routine parameters to explore the influencing factors of TEG detection.Results 22.8%(46/202)of the 202 volunteers had at least one TEG parameter outside the manufacturer’s reference range,and the specificity was 77.2%,which was significantly different from the 95%accuracy rate set by the manufacturer.Biochemical and blood routine results were analyzed and divided into the normal group,PLT group,WBC group,GLU group,TG group and HCT group.The results showed that:compared with the normal group,parameters K,α-Angle and MA were significantly different in PLT group and WBC group(P<0.05),but were not significantly different from GLU group,TG group and HCT group(P>0.05).Parameter R was the main reason for the low overall specificity of TEG parameter,and there was no statistical significance between the normal group and 5 abnormal groups(P>0.05),which was not affected by the above parameters.There was no significant difference in parameter R between different genders and different age groups(P>0.05).Conclusion R is the only parameter that needs to be established through multi-center joint reference range.Leukocyte and platelet have influence on TEG parameters K,α-Angle and MA.