血栓弹力图对急性白血病患者出血风险的评估及诊断价值

The role of TEG in the assessment and diagnostic value of bleeding risk in patients with acute leukemia

目的探讨血栓弹力图(thrombelastogram,TEG)对急性白血病(acute leukemia,AL)患者出血风险的评估及诊断价值。方法选取2015年6月至2018年3月在西安市中心医院住院治疗的初发AL患者130例,均经过骨髓涂片、活检等确诊。根据有无出血将患者分为出血组(n=51)和无出血组(n=79)。统计血小板计数(platelet,PLT)、TEG各项指标,TEG指标包括凝血反应时间、血凝块生成时间、凝固角和最大振幅。采用ROC曲线评估不同指标预测出血风险的价值。结果出血组凝血反应时间和血凝块生成时间均高于无出血组,而凝固角和最大振幅均低于无出血组,差异有显著性(P<0.05);出血组PLT低于无出血组,差异有显著性(P<0.05)。PLT<30×10~9/L的出血组患者血凝块生成时间高于PLT<30×10~9/L的无出血组患者,差异有显著性(P<0.05),而凝固角和最大振幅低于PLT<30×10~9/L的无出血组患者,差异有显著性(P<0.05)。最大振幅和PLT的曲线下面积分别为0.792和0.811,二者比较差异无显著性(P>0.05)。结论联合TEG最大振幅与PLT对预测和评估AL患者的出血风险具有重要临床价值。

Objective To investigate the role of thromboelastography(TEG) in evaluating and diagnosing the risk of bleeding in patients with acute leukemia(AL). Method One hundred and thirty patients with AL in our hospital from June 2015 to March 2018 were included in this study. Patients were divided into bleeding group(n=51) and non-bleeding group(n=79) according to whether there was bleeding or not. PLT count, TEG and other data were record-TEG indicators include coagulation time, blood clot generation time, solidi? cation angle and maximum amplitude. ROC curve was used to evaluate the value of different indicators in predicting bleeding risk. Result The time of coagulation reaction and the time of blood clot formation in bleeding group were all higher than non-bleeding group, but the coagulation angle and the maximum amplitude were lower than non-bleeding group(P<0.05), and the PLT count in the bleeding group was lower than non-bleeding group, and the difference was statistically signi? cant(P<0.05). The time of blood clot formation(PLT<30×10~9/L)in bleeding group was higher than non-bleeding group. The difference was statistically signi? cant(P<0.05), but the coagulation angle and maximum amplitude in bleeding group were lower than non-bleeding group(P<0.05). The area under the curve of maximum amplitude and PLT count was 0.792 and 0.811, respectively, and there was no significant difference between the two groups(P>0.05). Conclusion The maximum amplitude of TEG can be used as an effective complement to PLT count. It has important clinical value in predicting and evaluating the bleeding risk of AL patients.