Liu Chen, Guan Zhao, Xu Qinzhu, Zhao Lei, Song Ying, Wang Hui
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
Medicine (Baltimore). 2016 Jun;95(24):e3934. doi: 10.1097/MD.0000000000003934.
Fractures are common among aged people, and rapid assessment of the coagulation status is important. The thromboelastography (TEG) test can give a series of coagulation parameters and has been widely used in clinics. In this research, we looked at fracture patients over 60 and compared their TEG results with those of healthy controls. Since there is a paucity of studies comparing TEG assessments with conventional coagulation tests, we aim to clarify the relationship between TEG values and the values given by conventional coagulation tests.Forty fracture patients (27 femur and 13 humerus) over 60 years old were included in the study. The change in their coagulation status was evaluated by TEG before surgery within 4 hours after the fracture. Changes in TEG parameters were analyzed compared with controls. Conventional coagulation test results for the patients, including activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, and platelets, were also acquired, and correlation analysis was done with TEG parameters, measuring similar aspects of the coagulation cascade. In addition, the sensitivity and specificity of TEG parameters for detecting raised fibrinogen levels were also analyzed.The K (time to 20 mm clot amplitude) and R (reaction time) values of aged fracture patients were lower than controls. The values for angle, maximal amplitude (MA), and coagulation index (CI) were raised compared with controls, indicating a hypercoagulable state. Correlation analysis showed that there were significant positive correlations between fibrinogen and MA/angle, between platelets and MA, and between APTT and R as well. There was significant negative correlation between fibrinogen and K. In addition, K values have better sensitivity and specificity for detecting elevated fibrinogen concentration than angle and MA values.Aged fracture patients tend to be in a hypercoagulable state, and this could be effectively reflected by a TEG test. There were correlations between TEG parameters and corresponding conventional tests. K values can better predict elevated fibrinogen levels in aged fracture patients.
骨折在老年人中很常见，快速评估凝血状态很重要。血栓弹力图（TEG）检测可以给出一系列凝血参数，已在临床上广泛应用。在本研究中，我们观察了60岁以上的骨折患者，并将他们的TEG结果与健康对照组进行比较。由于比较TEG评估与传统凝血检测的研究较少，我们旨在阐明TEG值与传统凝血检测值之间的关系。
本研究纳入了40名60岁以上的骨折患者（27例股骨骨折和13例肱骨骨折）。在骨折后4小时内手术前通过TEG评估他们凝血状态的变化。将TEG参数的变化与对照组进行分析比较。还获取了患者的传统凝血检测结果，包括活化部分凝血活酶时间（APTT）、国际标准化比值（INR）、纤维蛋白原和血小板，并与TEG参数进行相关性分析，这些参数测量了凝血级联反应的相似方面。此外，还分析了TEG参数检测纤维蛋白原水平升高的敏感性和特异性。
老年骨折患者的K值（达到20毫米凝块振幅的时间）和R值（反应时间）低于对照组。与对照组相比，角度、最大振幅（MA）和凝血指数（CI）值升高，表明处于高凝状态。相关性分析表明，纤维蛋白原与MA/角度之间、血小板与MA之间以及APTT与R之间存在显著正相关。纤维蛋白原与K之间存在显著负相关。此外，K值在检测纤维蛋白原浓度升高方面比角度和MA值具有更好的敏感性和特异性。
老年骨折患者往往处于高凝状态，这可以通过TEG检测有效反映出来。TEG参数与相应的传统检测之间存在相关性。K值可以更好地预测老年骨折患者纤维蛋白原水平的升高。
