多项指标联合检测对静脉血栓栓塞发生的预测价值

The predictive value of combined detection of multiple indicators for venous thromboembolism

目的探讨血栓弹力图(TEG)、凝血和血小板参数联合检测对预测静脉血栓栓塞(VTE)发生的价值。方法选择2020年8月至2021年9月于该院住院治疗的疑似VTE的患者153例为研究对象,经检查确诊为VTE的患者39例为VTE组,非VTE患者114例为非VTE组。检测所有患者TEG、凝血和血小板参数;采用多因素Logistic回归分析VTE发生的影响因素;采用受试者工作特征曲线分析各指标的检验效能;联合所有预测因子进行VTE发生的预测模型构建。结果与非VTE组比较,VTE组的TEG参数的反应时间(R)缩短(P<0.05);凝血指标的凝血酶原时间(PT)缩短、国际标准化比率降低,D-二聚体水平升高(P<0.05);血小板参数的血小板分布宽度、平均血小板体积(MPV)、大血小板比率降低,血小板压积升高(P<0.05)。多因素Logistic回归分析结果显示,PT、D-二聚体、R和MPV是VTE发生的独立影响因素。联合D-二聚体、MPV、R和PT建立预测模型,其预测VTE发生的曲线下面积为0.878,灵敏度和特异度分别为64.54%及93.86%。结论联合TEG、凝血和血小板参数对VTE发生具有一定的预测价值。

Objective To investigate the value of thromboelastography(TEG),combined with coagulation and platelet parameters in predicting the occurrence of venous thromboembolism(VTE).Methods A total of 153 patients with suspected VTE who were hospitalized in this hospital from August 2020 to September 2021 were selected as the research objects.A total of 39 diagnosed with VTE were selected as the VTE group,and 114 patients without VTE were selected as the non-VTE group.TEG,coagulation and platelet parameters were measured.Multivariate Logistic regression was used to analyze the influencing factors of VTE.Receiver operating characteristic curve was used to analyze the test efficacy of each index.The prediction model of VTE occurrence was constructed by combining all predictors.Results Compared with non-VTE group,the reaction time(R)of TEG parameters in VTE group was significantly decreased(P<0.05).The prothrombin time(PT)and international normalized ratio of coagulation indexes were decreased,and the level of D-dimer was increased(P<0.05).Platelet parameters such as platelet distribution width,mean platelet volume(MPV),and large platelet ratio were decreased,and the level of thrombocytocrit was increased(P<0.05).Multivariate Logistic regression analysis showed that PT,D-dimer,R and MPV were independent risk factors for VTE.The area under the curve of VTE prediction model established by combining D-dimer,MPV,R and PT was 0.878,and the sensitivity and specificity were 64.54%and 93.86%,respectively.Conclusion The combination of TEG,coagulation and platelet parameters has certain predictive value for VTE.