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[不同凝血状态下血栓弹力图与凝血功能及血小板计数的关系]

[Relation of Thromboelastography with Coagulation Function and Plt Count in Different Coagulation States].

作者信息

Wen Xian-Hui, Zhang Jun-Hua, Gui Rong

机构信息

Department of Blood Transfusion, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China.

Department of Blood Transfusion, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China.E-mail:

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2018 Dec;26(6):1793-1799. doi: 10.7534/j.issn.1009-2137.2018.06.035.

DOI:10.7534/j.issn.1009-2137.2018.06.035
PMID:30501722
Abstract

OBJECTIVE

To investigate the correlation and consistency between thromboelastography (TEG) and routine tests, platelets count in different coagulation states (hypercoagulable, low coagulation, and normal coagulation) and to evaluate the clinical value of TEG, routine bloot test and Plt count.

METHODS

The clinical data of 409 patients performed the TEG, coaglation 4 test and blood routine test in third Xiangya Hosptial of Central Sonth University from January 2015 to December 2017 were analyzed retrospectively. The TEG main parameters such as the activation time of clothing factor (R), the formation rate of blood clots (K), the maximal α-angle (Angle) and maximal amplitude (MA) were compared with prothrombin time (PT), activated partial thromboplastin time (APTT), fibrin (Fib), thrombin time (TT) in blood routine test as well as platelet (Plt) counts by using the person correlation, Kappa consistency and paired chi-square test in different coagulation states, at the same time the guiding rote of these 2 detection mathods for clinical application of blood was compared.

RESULTS

R value positively correlated with PT, the correlation coefficient (r) under low, high and normal coagulation status was 0.376, 0.316 and 0.276 respectively (P<0.05); the Kruskal-Wallis test of pairwise comparison showed no statistical difference (P>0.05); the consistency of R with PT under low, high and normal coagalation status was 0.208, 0.227 and 0.131, respectively. The R value positively correlated with APTT, r value under low, high and normal coagulation status was 0.418, 0.258 and 0.458 respectively (P<0.05); the Kruskal Walls test of pairwise comparion showed that there was no difference between value of low and normal coagulation status (P>0.05), while there was difference between r value of low and high coagulation status (P<0.05), the consistences of R value with APTT under low, high and normal coagulatiom status was 0.338, 0.291 and 0.161, with statistical difference (P<0.05). K value negatively correlated with Fib, r value under low, high and mornal coagulation status was -0.611, -0.411 and 0.311 respectively (P<0.05); the Kruskal-Wallis test of pairwise comparison all showed that statistical difference (P<0.05); the consistencey of K value with Fib was 0.432, 0.481 and 0.323 respectively under low, high and normal coagulation states. K value negatively correlated with plt count, r value under low, high and normal coagulation status was -0.278, -0.238 and -0.278 respectively (P<0.05); the consistency of K value with Fib level under low,high and normal coagulation status was 0.401, 0.312 and 0.279 respectively(P<0.05). Angle postively correlated with Fib level, r value under low, high and normal coagulation status was 0.638, 0.538 and 0.438 respectively (P<0.05); the Kruskal-Wallis test of pairwise comparison showed the statistical difference (P<0.05); the consistency of Angle with under low,high and normal coagulation status Fib was 0.323, 0.357 and 0.288 respectively(P<0.05). MA value positively correlated with Fib level (r=0.351, 0.381 and 0.211, P<0.05); the Kruskal-Wallis test of pairwise comparison showed that there was no difference of r value under low- and high-coagulation states (P>0.05), while there were differences of r values under low- and high-coagulation states with normal coagulation (P<0.05); the consistency of MA with Fib level under 3 kinds of coagulation states was 0.510, 0.467 and 0.427 respectively (P<0.05). MA value positively correlated with Plt count (r=0.478, 0.515 and 0.378) respectively under 3 kinds of coagulation states; the Kruskal-Wallis test of pairuse comparison both showed the statistical difference (P<0.05); the consistency of MA with Plt count under 3 kinds of coagulation status was 0.581, 0.461 and 0.350 (P<0.05).

CONCLUSION

The TEG correlates with results of blood coagulation test and Plt detection; the correlation and consistecy of TEG with routine blood coagalation test and Plt detection are different under different status. Therefore, for patients who possibly had pathologic hyper- and hypo-coagulation, the TEG detection should be performed, so as to dynamically monitor the blood coagulation in vivo, guide the rational use of drugs and blood transfusion, reduce the risk of embolion and blood transfusion.

摘要

目的

探讨血栓弹力图(TEG)与常规凝血指标及不同凝血状态(高凝、低凝、正常凝血)下血小板计数的相关性及一致性,评估TEG、常规凝血检查及血小板计数的临床应用价值。

方法

回顾性分析2015年1月至2017年12月在中南大学湘雅三医院行TEG、凝血四项及血常规检查的409例患者的临床资料。采用Person相关分析、Kappa一致性检验及配对卡方检验,比较TEG主要参数如凝血因子激活时间(R)、血栓形成速率(K)、最大α角(Angle)和最大振幅(MA)与凝血四项指标中凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)以及血常规中血小板(Plt)计数在不同凝血状态下的相关性及一致性,同时比较两种检测方法对临床用血的指导作用。

结果

R值与PT呈正相关,低凝、高凝及正常凝血状态下相关系数(r)分别为0.376、0.316及0.276(P<0.05);两两比较的Kruskal-Wallis检验差异无统计学意义(P>0.05);低凝、高凝及正常凝血状态下R与PT的一致性分别为0.208、0.227及0.131。R值与APTT呈正相关,低凝、高凝及正常凝血状态下r值分别为0.418、0.258及0.458(P<0.05);两两比较的Kruskal-Wallis检验显示低凝与正常凝血状态下r值差异无统计学意义(P>0.05),低凝与高凝状态下r值差异有统计学意义(P<0.05),低凝、高凝及正常凝血状态下R值与APTT的一致性分别为0.338、0.291及0.161,差异有统计学意义(P<0.05)。K值与Fib呈负相关,低凝、高凝及正常凝血状态下r值分别为-0.611、-0.411及0.311(P<0.05);两两比较的Kruskal-Wallis检验差异均有统计学意义(P<0.05);低凝、高凝及正常凝血状态下K值与Fib的一致性分别为0.432、0.481及0.323。K值与Plt计数呈负相关,低凝、高凝及正常凝血状态下r值分别为-0.278、-0.238及-0.278(P<0.05);低凝、高凝及正常凝血状态下K值与Plt水平的一致性分别为0.401、0.312及0.279(P<0.05)。Angle与Fib水平呈正相关,低凝、高凝及正常凝血状态下r值分别为0.638、0.538及0.438(P<0.05);两两比较的Kruskal-Wallis检验差异有统计学意义(P<0.05);低凝、高凝及正常凝血状态下Angle与Fib的一致性分别为0.323、0.357及0.288(P<0.05)。MA值与Fib水平呈正相关(r=0.351、0.381及0.211,P<0.05);两两比较的Kruskal-Wallis检验显示低凝与高凝状态下r值差异无统计学意义(P>0.05),低凝、高凝与正常凝血状态下r值差异有统计学意义(P<0.05);三种凝血状态下MA与Fib水平的一致性分别为0.510、0.467及0.427(P<0.05)。MA值与Plt计数呈正相关(r=0.478、0.515及0.378),三种凝血状态下两两比较的Kruskal-Wallis检验差异均有统计学意义(P<0.05);三种凝血状态下MA与Plt计数的一致性分别为0.581、0.461及0.350(P<0.05)。

结论

TEG与凝血检查结果及Plt检测具有相关性;不同状态下TEG与常规凝血检查及Plt检测的相关性及一致性不同。因此,对于可能存在病理性高凝及低凝的患者,应行TEG检测,以动态监测体内凝血状态,指导合理用药及输血,降低栓塞及输血风险。

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