血栓弹力图、D-二聚体、载脂蛋白E联合检测骨折患者凝血状态的分析

Analysis of Thrombelastogram,D-dimer and Plasma Apolipoprotein E Combined to Detect Coagulation Status in Fracture Patients

目的:探讨血栓弹力图(TEG)、D-二聚体(D-D)和血浆载脂蛋白E(ApoE)联合检测对骨折患者术前血凝状态的诊断价值。方法:选取2020年9月-2022年3月南京中医药大学附属盐城市中医院收治的骨折手术患者66位为观察组,同期体检人员45例为对照组。采集静脉血,比较两组D-D、TEG{综合参数[凝血综合指数(CI)]、凝血因子功能[凝血时间(R)]、纤维蛋白原功能[包括凝固时间(K)、凝固角(α角)]及血小板聚集功能[血块强度(MA)]}、ApoE指标;分析ApoE与TEG参数、D-D的相关性。结果:观察组D-D水平、R值、K值、ApoE均高于对照组,CI值、α角和MA值均低于对照组,差异有统计学意义(P<0.05);观察组ApoE值与MA值呈正相关(P<0.05),与CI值、R值、K值、α角和D-D值无相关性(P>0.05)。结论:患者在骨折发生后、抗凝治疗或手术前存在凝血功能异常,TEG结果显示患者纤维蛋白水平减低、血小板功能下降、凝血因子活性降低,患者处于低凝状态,D-D和ApoE水平增高提示患者易形成血栓。TEG各项参数联合D-D及ApoE指标能更加全面地反应骨折患者凝血功能状态,分析凝血功能异常原因,对骨折患者的治疗具有指导意义。

Objective:To explore the diagnostic value of thrombelastogram(TEG),D-dimer(D-D)and plasma apolipoprotein E(ApoE)in the preoperative hemagglutination of fracture patients.Methods:Sixty-six patients with fracture surgery admitted to Yancheng Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from September 2020 to March 2022 were selected as the observation group,and forty-five physical examination personnel during the same period were se⁃lected as the control group.Venous blood was collected and D-D,TEG{Comprehensive parameters[coagulation index(CI)],coagu⁃lation factor function[coagulation time(R)],fibrinogen function[including coagulation time(K),coagulation angle(a angle)]and platelet aggregation function[clot strength(MA)]}and ApoE indexes of the two groups were compared.The correlation between ApoE and TEG parameters and D-D was analyzed.Results:The D-D level,R value,K value and ApoE value in the observation group were higher than those in the control group,while CI value,αangle and MA value were lower than those in the control group,with statistical significance(P<0.05).ApoE value in observation group was positively correlated with MA value(P<0.05),but had no correlation with CI value,R value,K value,αangle and D-D value(P>0.05).Conclusion:The patients had abnormal coagulation function after fracture,anticoagulant therapy or before surgery.TEG results showed that the patients were in a state of hypocoagulation with decreased fibrin level,decreased platelet function and decreased clotting factor activity,and the patients were in a state of hypocoagulation with increased D-D and ApoE levels suggesting that the patients were prone to thrombosis.TEG parameters combined with D-D and ApoE indexes can more comprehensively reflect the status of coagulation function in fracture patients,and analyze the causes of abnormal coagulation function,which has guiding significance for the treatment of frac⁃ture patients.