不同疾病中血栓弹力图与凝血4项对凝血功能的一致性分析

Consistency of thrombelastogram and coagulation indexes in analyzing coagulation function

摘要:

目的 探讨不同疾病中血栓弹力图与凝血4项对凝血功能的一致性研究。方法 选取2016年1月— 2017年6月泰州市人民医院进行治疗的糖尿病、脑出血、肝硬化、骨折、宫颈癌患者283例，所有患者均进行凝血4项和血栓弹力图检测，并采用全血细胞分析血小板计数（PLT）判定患者的凝血功能，对两种诊断方法之间的一致性和相关性进行分析。结果 糖尿病患者：凝血酶原时间（PT）与凝血反应时间（R值）呈正相关，与凝固角（α-Angle）呈负相关；活化部分凝血活酶时间（APTT）与R值呈正相关，与α-Angle和最大振幅（MA）呈负相关；纤维蛋白原（FIB）与R值、凝血形成时间（K值）呈负相关，与MA、α-Angle呈正相关；PLT与K值呈负相关、与α-Angle、MA呈正相关（P?<0.05）。脑出血患者：PT与R值呈正相关，与α-Angle、MA呈 负相关；APTT与R值呈正相关，与α-Angle呈负相关；FIB与R值、K值呈负相关，与MA、α-Angle呈正相关；PLT与K值呈负相关、与α-Angle、MA呈正相关。肝硬化患者：PT与R值、K值呈正相关，与α-Angle、MA 呈负相关；APTT与K值、R值呈正相关，与α-Angle、MA呈负相关；FIB与K值呈负相关，与MA、α-Angle 呈正相关；PLT与K值呈负相关、与α-Angle、MA呈正相关。骨折患者：PT与MA呈负相关；APTT与R值呈 正相关，与α-Angle存在负相关；FIB与R值呈负相关，与MA、α-Angle呈正相关；PLT与R值、K值呈负 相关（P?<0.05）。宫颈癌患者：PT与R值、K值呈正相关，与MA、α-Angle呈负相关；APTT与R值、K 值呈正相关，与MA、α-Angle呈负相关；FIB与R值呈负相关，与MA呈正相关；PLT与R值、K值呈负相关 （P?<0.05）。结论 在糖尿病、脑出血、肝硬化、宫颈癌患者中应用血栓弹力图与凝血4项检测，两者之间具有相关性，两种方法均能够良好地反应患者的出血风险，值得临床进一步应用与推广。

Abstract:

Objective To compare the consistency of thromboelastogram and coagulation indexes in evaluating coagulative function. Methods A total of 283 patients with diabetes mellitus, cerebral hemorrhage, cirrhosis, fractures or cervical cancer who were admitted into Taizhou People’s Hospital from January 2016 to June 2017 were involved in this study. All patients were tested for coagulation indexes and thrombelastography, and the hematopoietic function was determined by platelet count. The consistency and correlation between the two diagnostic tools were analyzed. Results In diabetic patients: prothrombin time (PT) was positively correlated with clotting reaction time (R value) and negatively correlated with α-Angle; activated partial thromboplastin time (APTT) was positively correlated with R value, and negatively correlated with α-Angle and maximum amplitude (MA); fibrinogen (FIB) was negatively correlated with R value and coagulation formation time (K value), and positively correlated with MA and α-Angle; PLT presence was negatively correlated with K value, and positively correlated with α-Angle and MA. In patients with intracerebral hemorrhage: PT was positively correlated with R values, and negatively correlated with α-Angle and MA; APTT values was positively correled with the R value, and was negatively correlated with the presence of α-Angle; FIB was negatively correlated with K value, and was positively correlated with MA and α-Angle; PLT presence was negatively correlated with K value, and was positively correlated with α-Angle and MA. In patients with cirrhosis: PT was positively correlated with and R value and K value, while was negatively correlated with α-Angle and MA. APTT was positively correlated with and R value and K value, while was negatively correlated with α-Angle and MA; FIB was negatively correlated with the K value while was positively correlated with MA and α-Angle; PLT presence was negatively correlated with K and was positively correlated with α-Angle and MA. In fracture patients: There was a negative correlation between PT and MA; APTT values existed a positive correlation with the R value, while was negatively correlated with the presence of α-Angle; there was a negative correlation between FIB and R value and a positive correlation with MA and α-Angle; there was a negative correlation between PLT and K values. In cervical cancer patients: PT was positively correlated with R value, K value, and negatively correlated with MA and α-Angle; there was a positive correlation between APTT and R value/K value, but a negative correlation between APTT and MA/α-Angle; FIB existed a negative correlation with the R value, and a positive correlation with MA; There was a negative correlation between PLT and R values/K values. Discussion In patients with diabetes mellitus, cerebral hemorrhage, cirrhosis, bone fracture and cervical cancer, coagulation indexes and thrombelastogram are well coagulated and is worth further clinical application.