血栓弹力图和常规凝血试验对脑血管病术后下肢深静脉血栓形成的诊断价值

The value of thromboelastography and routine coagulation tests in diagnosis of lower limbs deep venous thrombosis after cerebrovascular disease surgery

目的探讨血栓弹力图(TEG)和常规凝血试验对脑血管病术后下肢深静脉血栓(DVT)形成的诊断价值。方法回顾性分析60例行下肢深静脉检查的脑血管病术后患者的临床资料,依据有无下肢DVT形成将患者分为血栓组(33例)和正常组(27例)。比较两组患者TEG及常规凝血功能指标,分析TEG以及常规凝血功能指标对脑血管病术后患者下肢DVT形成的诊断价值。结果血栓组纤维蛋白原(Fib)、D-二聚体(D-D)和凝血形成速率(α角)均高于正常组(P<0.05),凝血生成时间(K值)低于正常组(P<0.05)。ROC曲线分析发现,Fib、D-D、α角、K值诊断下肢DVT形成的AUC分别为0.68、0.65、0.67、0.66,当取最佳诊断界值分别为3.22g/L、732ng/mL、69.9度、1.3min时,其诊断下肢DVT形成的灵敏度分别为54.5%、60.6%、78.8%、72.7%,特异度分别为81.5%、74.1%、59.3%、59.3%。结论TEG和常规凝血检查对脑血管病术后下肢DVT形成均具有一定的诊断价值。

Objective To investigate the diagnostic value of thromboelastography(TEG)and routine coagulation tests in the formation of deep venous thrombosis(DVT)in the lower limbs after cerebrovascular disease surgery.Methods The clinical data of 60patients underwent deep vein examination of the lower limbs after cerebrovascular disease surgery were retrospectively analyzed.The patients were divided into two groups of A(with DVT formation,33cases)and C(without DVT formation,27cases).TEG and conventional coagulation function indexes were compared between the two groups,and the diagnostic value of TEG and conventional coagulation function indexes in the formation of the lower limbs DVT formation was analyzed.Results Fibrinogen(Fib),D-dimer(D-D)and coagulation rate(αangle)were higher,while coagulation time(K value)was lower in group A than those in group C(P<0.05).The AUC values under the ROC curves formed by Fib,D-D,αangle and K value in the diagnosis of lower limbs DVT formation were 0.68,0.65,0.67and 0.66,respectively.When the optimal diagnostic cut-off values of Fib,D-D,αangle and K value were 3.22g/L,732ng/mL,69.9degrees and 1.3minutes,the sensitivity for diagnosing lower limbs DVT formation was 54.5%,60.6%,78.8%and 72.7%,and the specificity was 81.5%,74.1%,59.3%and 59.3%,respectively.Conclusion Both TEG and conventional coagulation tests have certain diagnostic value for the formation of DVT in the lower limbs after cerebrovascular disease surgery.