血栓弹力图在评价非瓣膜性房颤患者血栓栓塞风险中的临床价值

Clinical value of thromboelastograph in evaluating thromboembolic risk in patients with nonvalvular atrial fibrillation

目的探讨血栓弹力图(TEG)检测在评估非瓣膜性房颤患者血栓栓塞风险中的价值。方法选取尚未服用抗凝剂的非瓣膜性房颤患者60例,按照房颤卒中风险评估《CHA2DS2-VASc评分标准》(0分、1分、≥2分3个标准)分为低危组(14例)、中危组(22例)、高危组(24例)。同期将入选30例年龄、性别等相匹配的窦性心律患者作为对照组,于次日清晨行血常规、凝血功能等指标,比较各项指标在各组间的差异。结果房颤组与对照组在血红蛋白(Hb)、血小板计数(PLT)、PT、APTT指标间差异无统计学意义(P>0.05),在FIB、D-D指标间差异有统计学意义(P<0.05)。房颤组TEG参数中R值和K值明显低于对照组,差异有统计学意义(P<0.05);房颤组Angle角、MA、Cl值明显高于对照组,差异有统计学意义(P<0.05)。随着CHA2DS2-VASc评分的不同,低危组、中危组、高危组3组间的R值、K值、Angle角、MA值、Cl值差异有统计学意义;与低危组比较,高危组TEG参数中R值、K值缩短,Angle角、MA值、Cl值增大,差异有统计学意义(P<0.05);与中危组比较,高危组TEG参数中R值缩短,Angle角、MA值、Cl值增大,差异有统计学意义(P<0.05)。Person相关分析显示,R值、K值与D-D、FIB呈负相关性,Angel角、MA值、Cl值与D-D、FIB呈正相关性。结论非瓣膜性房颤患者存在血栓前状态,TEG参数与凝血功能指标D-D、FIB具有相关性,TEG在非瓣膜性房颤患者血栓栓塞风险评估中具有一定的参考价值。

Objective To assess clinical value of thromboelastograph( TEG) in monitoring thromboembolic risk in patients were recruited with nonvalvular atrial fibrillation( NVAF). Methods 60 nonvalvular atrial fibrillation patients without prior anticoagulant,according to CHA2DS2- VASc scores( 0,1,≥2),the NVAF patients were divided into low- intermediate group and high risk group respectively. And another 30 patients with sinus rhythm served as controls whose sex age and condition were matched with the NVAF patients. Routine TEG parameters,conventional coagulation examinations of prothrombin time,activated partial thromboplastin time,serum levels of fibrinogen,D- Dimer and blood routine tests had taken out on admission and compared between 2 groups. Results The patients with atrial fibrillation had no significant differences on PT,APTT,PLT,Hb than those with the controls( P > 0. 05); The patients with atrial fibrillation had significant differences on FIB,D- D than those with the controls( P < 0. 05). The TEG parameters in patients with nonvalvular Atrial fibrillation had statistical significance and significantly lower levels on R,K values than those in the controls and higher levels on ANGLE,MA and CL than those in the controls( P < 0. 05). With differences CHA2DS2- VASc scores,significant differences existed between the low- intermediate group and high risk group of TEG parameters with R,K,ANGLE,MA and CL. Group with higher CHA2DS2- VASc scores had higher ANGLE,MA and CL than those in the low- intermediate group and lower R,K values than those in the low- intermediate group( P < 0. 05). The correlation analysis of Person showed R,K and FIB,D- D were negatively correlated,however,ANGLE,MA,CLand FIB,D- D were positively correlated. Conclusion Nonvalvular atrial fibrillation patients are in a prothrombotic state and there was relationship between TEG parameters and FIB,D- D in patients with NVAF,the TEG had superior reference value in assessment of the risk of thrombembolia in patients with nonvalvular atrial fibrillation.