Shin Kyung Hwa, Kim In Suk, Lee Hyun Ji, Kim Hyung Hoi, Chang Chulhun L, Hong Young Mi, Yoon Ki Tae, Cho Mong
Department of Laboratory Medicine, Pusan National University School of Medicine and Biomedical Research Institute Research Institute, Pusan National University Hospital, Busan, Korea.
Department of Laboratory Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Ann Lab Med. 2017 May;37(3):204-212. doi: 10.3343/alm.2017.37.3.204.
The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting.
We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA). Platelet count, prothrombin time international normalized ratio (PT INR), albumin, bilirubin, and creatinine were simultaneously measured. The CLD severity was calculated by using the Child-Pugh (C-P) and Model for End-stage Liver Disease (MELD) scores. Transfusion history was also reviewed.
All TEG parameters, PT INR, and platelet count in the cirrhotic group showed significant differences from those in other groups. At least one or more abnormal TEG parameters were identified in 17.3% and 44.7% of patients in the non-cirrhotic and cirrhotic group, respectively. Patients with cirrhotic disease had hypocoagulability. A weak correlation between R and PT INR (r=0.173) was noted. The TEG parameters could not predict CLD severity using the C-P and MELD scores. Patients with normal TEG parameters did not receive transfusion.
Clinical application of TEG measurements in CLD can be informative for investigating coagulopathy or predicting the risk of bleeding. Further studies are warranted.
本研究旨在探讨血栓弹力图（TEG）参数在评估慢性肝病（CLD）患者凝血病中的应用，并揭示其与疾病严重程度和/或输血需求之间的关联。
我们纳入了两组成年患者，分别为肝硬化患者（N = 123）、非肝硬化肝病患者（N = 52）以及84名健康对照者。使用美国Haemonetics公司的TEG 5000系统，通过高岭土激活的枸橼酸盐血测定反应时间（R）、动力学时间（K）、α角（α）、最大振幅（MA）和凝血指数（CI）。同时测定血小板计数、凝血酶原时间国际标准化比值（PT INR）、白蛋白、胆红素和肌酐。采用Child-Pugh（C-P）评分和终末期肝病模型（MELD）评分计算CLD严重程度。还回顾了输血史。
肝硬化组的所有TEG参数、PT INR和血小板计数与其他组相比均有显著差异。非肝硬化组和肝硬化组分别有17.3%和44.7%的患者至少有一项或多项TEG参数异常。肝硬化患者存在低凝状态。R与PT INR之间存在弱相关性（r = 0.173）。TEG参数无法使用C-P和MELD评分预测CLD严重程度。TEG参数正常的患者未接受输血。
TEG检测在CLD中的临床应用有助于研究凝血病或预测出血风险。有必要进一步研究。
