血栓弹力图与热射病患者肝损伤相关指标的相关性分析

Correlation analysis between thromboelastography and liver injury related indexes in patients with heat stroke

目的 分析血栓弹力图各指标与热射病患者肝损伤相关指标的相关性,并探讨血栓弹力图各指标对热射病患者肝损伤的诊断价值。方法 选取2019年8月—2022年7月中国人民解放军联勤保障部队第924医院收治的劳力性热射病患者95例,根据是否存在肝损伤分为未并发肝损伤组(55例)与肝损伤组(40例),使用TEG仪器进行血栓弹力图检测,记录TEG参数-反应时间(R)、凝集时间(K)、α角、最大振幅(MA值)、凝血综合指数(CI),全自动生化分析仪检测患者天冬氨酸转氨酶(aspartate aminotransferase, AST)、丙氨酸转氨酶(alanine aminotransferase, ALT)、总胆红素(total bilirubin, TBil)、白蛋白(albumin, ALB)水平;采用Pearson法分析肝损伤热射病患者血栓弹力图指标R、K、α角、CI与肝功能指标AST、ALT、TBil、ALB的相关性;采用受试者工作特征曲线法(receiver operating characteristic curve, ROC)分析血栓弹力图指标R、K、α角、CI以及联合检测对热射病患者肝损伤的预测价值。结果 与未并发肝损伤组相比,肝损伤组热射病患者AST、ALT、TBil水平升高(t=26.174, 16.923, 18.414, P<0.05),ALB水平降低(t=24.596, P<0.05);与未并发肝损伤组相比,肝损伤组热射病患者R、K升高(t=58.014, 52.862, P<0.05),α角、CI降低(t=46.853, 60.717, P<0.05);热射病并发肝损伤患者R与AST、ALT正相关(r=0.532, 0.610, P<0.001),与ALB负相关(r=-0.551, P<0.001);K与AST、ALT、TBil正相关(r=0.661, 0.531, 0.504, P<0.001);α角与AST、ALT负相关(r=-0.473,-0.448, P<0.001),与ALB正相关(r=0.539, P<0.001);CI与AST、ALT、TBil负相关(r=-0.458,-0.505,-0.549, P<0.01);血栓弹力图指标R、K、α角、CI预测热射病患者肝损伤的曲线下面积为0.807(灵敏度为70.0%、特异度为81.6%)、0.831(灵敏度为77.5%、特异度为85.5%)、0.747(灵敏度为67.5%、特异度为74.5%)、0.788(灵敏度为77.5%、特异度为83.6%);联合检测预测热射病患者肝损伤的曲线下面积为0.967(灵敏度为92.5%、特异度为91.9%)。结论 血栓弹力图指标与热射病患者肝损伤相关指标具有相关性,血栓弹力图各指标有助于诊断热射病患者的肝损伤。

Objective To analyze the correlation between the thromboelastography(TEG)indexes and the indexes related to liver injury in patients with heat stroke,and explore the diagnostic value of TEG indexes for liver injury in patients with heat stroke.Methods A total of 95 patients with exertional heat stroke(EHS)admitted to 924 Hospital of the Joint Service Support Force of the People′s Liberation Army of China from August 2020 to July 22 were selected,and divided into a non-liver injury group(55 cases)and a liver injury group(40 cases)according to whether there was liver injury.TEG instrument was used for the detection of thromboelastography to record the TEG parameters,including reaction time(R),agglutination time(K),αangle,maximum amplitude(MA value),and coagulation complex index(CI).The levels of glutamic transaminase(AST),alanine aminotransferase(ALT),total bilirubin(TBil),albumin(ALB)were detected by automatic biochemical analyzer.Pearson′s method was applied to analyze the correlation between thromboelastography indexes R,K,αangle,CI and liver function indexes AST,ALT,TBil,ALB in patients with heat stroke after liver injury.Receiver operating characteristic curve(ROC)was applied to analyze the predictive value of thromboelastography indexes R,K,αangle,CI and combined detection for liver injury in patients with heat stroke.Results Compared with the non-liver injury group,the AST,ALT and TBil levels in patients with heat stroke in the liver injury group were higher(t=26.174,16.923,18.414,P<0.05),while the ALB level was lower(t=24.596,P<0.05);compared with the non-liver injury group,the R and K of patients with heat stroke in the liver injury group were higher(t=58.014,52.862,P<0.05),and theαangle and CI were lower(t=46.853,60.717,P<0.05);R was positively correlated with AST and ALT(r=0.532,0.610,P<0.001),and negatively correlated with ALB(r=-0.551,P<0.001)in patients with heat stroke complicated with liver injury;K was positively correlated with AST,ALT and TBil(r=0.661,0.531,0.504,P<0.001);αangle was negatively correlated with AST and ALT(r=-0.473,-0.448,P<0.01),and positively correlated with ALB(r=0.539,P<0.001);CI was negatively correlated with AST,ALT and TBil(r=-0.458,-0.505,-0.549,P<0.001);the area under the curve(AUC)of thromboelastography indexes R,K,αangle and CI in predicting liver injury in patients with heat stroke was 0.807(sensitivity of 70.0%,specificity of 81.6%),0.831(sensitivity of 77.5%,specificity of 85.5%),0.747(sensitivity of 67.5%,specificity of 74.5%),and 0.788(sensitivity of 77.5%,specificity of 83.6%),respectively.The AUC of combined detection to predict liver injury in patients with heat stroke was 0.967(sensitivity of 92.5%,specificity of 91.9%).Conclusions The thromboelastography indexes are correlated with the indexes related to liver injury in patients with heat stroke,and the thromboelastography indexes are helpful to diagnose liver injury in patients with heat stroke.