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局限性前列腺癌手术患者血栓弹力图与传统凝血试验的比较

Comparison Between Thromboelastography and Conventional Coagulation Tests in Surgical Patients With Localized Prostate Cancer.

作者信息

Wang Zhengwei, Li Jing, Cao Qingwei, Wang Lei, Shan Fengzhi, Zhang Houyi

机构信息

1 Department of Urinary Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, China.

2 Department of Urinary Surgery, First People's Hospital of Jinan, Jinan, Shandong, China.

出版信息

Clin Appl Thromb Hemost. 2018 Jul;24(5):755-763. doi: 10.1177/1076029617724229. Epub 2017 Sep 5.

Abstract

We aimed to examine hypercoagulable and hypocoagulable conditions in patients with prostate cancer using thromboelastography (TEG) and correlate TEG parameters with conventional coagulation test. The t test was used for comparing TEG parameters and routine coagulation results. Spearman rank-order correlation was used to describe the relationship of TEG and conventional tests. Sensitivity, specificity, positive predictive values, and negative predictive values were determined for bleeding and thrombosis. Totally, 20 patients had active bleeding postoperatively, 16 of whom showed hypocoagulation on TEG test and 9 of whom showed hypocoagulation by routine coagulation test ( P = .024). Overall, 60 patients did not have active bleeding postoperatively, 51 of whom showed hypercoagulation detected by TEG test and 42 of whom showed hypercoagulation found by routine coagulation test ( P = .040). Remarkably, patients had a little higher fibrinogen (FIB) compared to controls. There was no statistical difference in any of the conventional coagulation indexes between the groups. Correlation analysis showed that reaction time (R) and coagulation time (K) were positively correlated with the prothrombin time-international normalized ratio (PT-INR) and negatively correlated with FIB ( P < .001). Contrarily, α-angle and maximum amplitude (MA) were negatively correlated with PT-INR but positively correlated with FIB. Significantly, MA showed the strongest correlation with FIB and R exhibited the strongest correlation with PT-INR. Sensitivity and specificity for bleeding and thrombosis in TEG were higher than those in conventional coagulation test. Accordingly, TEG might be superior in evaluating hypercoagulation and detecting the risk of bleeding in patients with prostate cancer.

摘要

我们旨在使用血栓弹力图(TEG)检查前列腺癌患者的高凝和低凝状态,并将TEG参数与传统凝血试验相关联。采用t检验比较TEG参数和常规凝血结果。Spearman等级相关用于描述TEG与传统试验之间的关系。确定出血和血栓形成的敏感性、特异性、阳性预测值和阴性预测值。共有20例患者术后出现活动性出血,其中16例在TEG试验中显示低凝,9例在常规凝血试验中显示低凝(P = 0.024)。总体而言,60例患者术后无活动性出血,其中51例在TEG试验中检测到高凝,42例在常规凝血试验中发现高凝(P = 0.040)。值得注意的是,患者的纤维蛋白原(FIB)略高于对照组。两组之间的任何传统凝血指标均无统计学差异。相关分析表明,反应时间(R)和凝血时间(K)与凝血酶原时间-国际标准化比值(PT-INR)呈正相关,与FIB呈负相关(P < 0.001)。相反,α角和最大振幅(MA)与PT-INR呈负相关,但与FIB呈正相关。显著的是,MA与FIB的相关性最强,R与PT-INR的相关性最强。TEG对出血和血栓形成的敏感性和特异性高于传统凝血试验。因此,TEG在评估前列腺癌患者的高凝状态和检测出血风险方面可能更具优势。

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