凝血因子ⅩⅢ联合血栓弹力图对急性白血病化疗骨髓抑制患者出血风险的预测价值

Predictive Value of Coagulation Factor Ⅷ Combined with Thromboelastography on Bleeding Risk of Patients with Acute Leukemia Chemotherapy and Myelosuppression

【目的】探讨凝血因子(F)联合血栓弹力图(TEG)对急性白血病化疗骨髓抑制患者出血风险的预测价值。【方法】检测86例急性白血病化疗骨髓抑制患者的F水平及TEG参数[凝固时间(K值)、反应时间(R值)、血栓形成的最大幅度(MA值)及血凝块聚合速率(Angle值)],根据患者骨髓抑制后48 h内出血情况将其分为出血组和无出血组,以Logistic多因素回归分析患者出血的相关因素,以受试者工作特征(ROC)曲线评估TEG相关指标及F水平对患者出血的预测价值。【结果】86例患者中,51例出血(出血组),占比59.30%;35例患者未出血(无出血组),占比40.70%。出血组感染例数占比高于无出血组,且MA值及F水平均低于无出血组(P<0.05);Logistic多因素回归分析结果显示,合并感染、MA值及F水平降低均为急性白血病化疗骨髓抑制患者出血的危险因素(P<0.05);ROC分析显示,MA值、F水平及二者联合预测患者出血的曲线下面积(AUC)分别为0.744、0.724及0.848,MA值、F水平单一预测患者出血的效能低于二者联合检测(P<0.05)。【结论】合并感染的急性白血病骨髓抑制患者随着MA值及F水平的降低,出血发生率明显升高;MA值及F水平对患者的出血风险具有一定的临床预测价值。

【Objective】To explore the predictive value of coagulation factor(F)combined with thromboelastography(TEG)on the bleeding risk of patients with acute leukemia chemotherapy and myelosuppression.【Methods】A total of 86 patients with acute leukemia chemotherapy and myelosuppression were tested for the coagulation F level and TEG parameters[coagulation time(K value),reaction time(R value),maximum thrombosis(MA value)and blood clot aggregation rate(Angle value)].According to the bleeding within 48 hours after bone marrow suppression,patients were divided into the bleeding group and no bleeding group.Logistic multivariate regression analysis was used to explore the related factors of bleeding in patients with acute leukemia chemotherapy for myelosuppression,and receiver operating characteristic curve(ROC)was used to determine the predictive value of TEG-related indicators and F levels in patients.【Results】Among 86 patients with acute leukemia bone marrow suppression during chemotherapy,51 patients had bleeding(the bleeding group),accounting for 59.30%(51/86);the remaining 35 patients had no bleeding(non-bleeding group),accounting for 40.70%(35/86).The proportion of infected cases in the bleeding group was higher than that in the non-bleeding group,and the MA value and F level were lower than those in the bleeding group(P<0.05).Logistic multivariate regression analysis showed that co-infection and reduced-MA value and F level were risk factors for bleeding in patients(P<0.05).ROC analysis showed that the bleeding risk by the area under the curve(AUC)of MA value,F level and the combination of the two parameters were 0.744,0.724,and 0.848,respectively.MA value and F level alone predict the bleeding risk in patients,however,their predictive powers were lower than the combination of the two(P<0.05).【Conclusion】With the decrease of MA value and F level,the incidence of bleeding in acute leukemia myelosuppressed patients with co-infection increased significantly;MA value and F level have a certain clinical predictive value for bleeding in patients.