血栓弹力图对COPD患者下肢深静脉血栓形成的预测价值

Predictive value of TEG for deep venous thrombosis of lower limbs in patients with chronic obstructive pulmonary disease

目的分析血栓弹力图(TEG)参数对COPD患者下肢深静脉血栓形成的预测价值。方法选择35例下肢深静脉血栓形成的COPD患者作为观察组,另选择同期的35例无下肢深静脉血栓形成的COPD患者作为对照组,收集患者入院后24 h内的TEG参数,包括凝血反应时间R值、血液凝固时间K值、凝固角α角及最大血块强度MA值、血常规、血气分析及基本资料,采用Logistic回归分析及受试者操作特征(ROC)曲线分析TEG各项参数对COPD患者下肢深静脉血栓形成的预测价值。结果R值、K值、α角与COPD患者下肢深静脉血栓形成有关(P均<0.05),R值的曲线下面积(AUC)为0.787(95%CI 0.679~0.895),K值的AUC为0.758(95%CI 0.646~0.870),α角的AUC为0.689(95%CI 0.565~0.812),MA值的AUC为0.660(95%CI 0.533~0.787);4组数值联合预测COPD患者下肢深静脉血栓形成灵敏度及特异度更高(AUC=0.882,95%CI 0.796~0.969,P<0.001),截断值为0.436,灵敏度为94%,特异度为80%。结论TEG中R值、K值及α角是COPD患者下肢深静脉形成的预测因素,R值、K值及α角均能良好预测COPD患者下肢深静脉血栓形成,且R值、K值、α角和MA四者联合预测灵敏度及特异度更高。

Objective To analyze the value of thromboelastogram(TEG)parameters in predicting deep venous thrombosis of the lower limbs in patients with chronic obstructive pulmonary disease(COPD).Methods Thirty-five COPD patients complicated with deep venous thrombosis of the lower limbs were assigned into the observation group,and 35 COPD patients without deep venous thrombosis of the lower limbs of the same period were recruited in the control group.TEG parameters(R value of coagulation reaction time,K value of blood coagulation time,αangle of coagulation and MA value of maximum clot intensity),routine blood test,blood gas analysis and baseline data were collected within 24 hours after admission.Logistic regression analysis and receiver operating characteristic(ROC)curve analysis were used to analyze the predictive value of all parameters of TEG for deep venous thrombosis of the lower limbs in patients with COPD.Results R value,K value andαangle were significantly correlated with deep venous thrombosis of the lower limbs in patients with COPD(all P<0.05).The area under the ROC curve(AUC)of R value was 0.787(95%CI:0.679-0.895),0.758 for K value(95%CI:0.646-0.870),0.689 forαangle(95%CI:0.565-0.812),and 0.660 for MA value(95%CI:0.533-0.787),respectively.The combination of four parameters yielded higher sensitivity and specificity for predicting deep venous thrombosis of the lower limbs(AUC:0.882,95%CI:0.796-0.969,all P<0.001),the cut-off value was 0.436,the sensitivity was 94.3%and the specificity was 80%,respectively.Conclusions R value,K value andαangle in TEG are the independent predictors of deep venous thrombosis of the lower limbs in patients with COPD.R value,K value andαangle can properly predict deep venous thrombosis of the lower limbs in patients with COPD,and the combination of R value,K value,αangle and MA value yields higher sensitivity and specificity.