CCT、TEG与免疫性血小板减少症患者血小板输注后出血的关系

The relationship between CCT, TEG, and platelet transfusion induced bleeding in patients with immune thrombocytopenia

摘要:

目的 探讨常规凝血试验（CCT）、血栓弹力图（TEG）与免疫性血小板减少症患者血小板输注后出血的关系。方法 回顾性分析2021年1月—2024年8月陕西省核工业二一五医院收治的156例行血小板输注的免疫性血小板减少症患者的临床资料。根据患者血小板输注后出血情况分为出血组（50例）与未出血组（106例）。比较两组一般资料［性别、年龄、急性生理与慢性健康状况Ⅱ（APACHE Ⅱ）评分、疾病分期、血型、基础疾病］、TEG指标［凝血反应时间（R）、血凝块形成时间（K）、凝固角（Angle）、最大振幅（MA）］及CCT指标［活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）、纤维蛋白原（FIB）］的差异。采用多因素逐步Logistic回归模型分析免疫性血小板减少患者血小板输注后出血的危险因素，绘制受试者工作特征曲线分析K、Angle、MA、PT、FIB预测免疫性血小板减少患者血小板输注后出血的价值。结果 出血组K、PT高于未出血组，Angle、MA和FIB低于未出血组（P <0.05）。多因素逐步Logistic分析结果显示：K值高［O^R =13.265（95% CI：2.985，58.948）］、MA值低［O^R =7.261（95% CI：1.124，46.906）］、Angle值低［O^R =11.124（95% CI：2.564，48.262）］、FIB值低［O^R =9.561（95% CI：2.135，42.816）］、PT值高［O^R =10.561（95% CI：2.263，49.286）］是免疫性血小板减少患者血小板输注后出血的危险因素（P <0.05）。K、Angle、MA、PT、FIB均可用于对免疫性血小板减少症患者血小板输注后出血的预测，其敏感性分别为80.0%（95% CI：0.721，0.843）、72.0%（95% CI：0.683，0.803）、80.0%（95% CI：0.685，0.803）、64.0%（95% CI：0.602，0.715）、72.0%（95% CI：0.675，0.796），特异性分别81.1%（95% CI：0.726，0.861）、79.2%（95% CI：0.764，0.832）、86.8%（95% CI：0.820，0.892）、77.4%（95% CI：0.732，0.863）、77.4%（95% CI：0.721，0.853）。结论 免疫性血小板减少症患者血小板输注后出血与K、Angle、MA、PT、FIB密切相关，临床应密切关注。

Abstract:

Objective To explore the relationship between routine coagulation test (CCT), thromboelastography (TEG), and platelet transfusion bleeding in patients with immune thrombocytopenia.Methods A retrospective analysis was conducted on the clinical data of 156 patients with immune thrombocytopenia who underwent platelet transfusion at Shaanxi Nuclear Industry 215 Hospital from January 2021 to August 2024. According to the bleeding situation after platelet transfusion in all patients, they were divided into a bleeding group (n = 50) and a non bleeding group (n = 106). Compare the differences between two sets of general information [gender, age, acute physiology and chronic health score (APACHE Ⅱ), disease staging, blood type, underlying diseases], TEG indicators [coagulation reaction time (R) value, blood clot formation time (K) value, coagulation angle (Angle), maximum amplitude (MA) value, and CCT indicators [activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), fibrinogen (FIB)] levels. Non conditional logistic stepwise regression analysis was conducted using multiple factors to identify the risk factors for post transfusion bleeding in patients with immune thrombocytopenia. Finally, ROC analysis was used to predict the value of post transfusion bleeding in immune thrombocytopenia patients based on K value, Angle, MA value, PT, and FIB levels.Results The comparison of K value, PT level, Angle, MA value, and FIB level between the bleeding group and the non bleeding group showed statistically significant differences (P < 0.05) through t-test; The K value and PT level in the bleeding group were higher than those in the non bleeding group, while the Angle, MA value, and FIB level were lower than those in the non bleeding group (P < 0.05). Multivariate logistic analysis showed that high K value [O^R =13.265 (95% CI: 2.985, 58.948) ], low MA value [O^R = 7.261 (95% CI: 1.124, 46.906) ], low Angle [O^R = 11.124 (95% CI: 2.564, 48.262) ], low FIB level [O^R = 9.561 (95% CI: 2.135, 42.816) ], and high PT level [O^R = 10.561 (95% CI: 2.263, 49.286) ] are risk factors for platelet transfusion bleeding in patients with immune thrombocytopenia (P < 0.05). ROC analysis confirmed that K value, Angle, MA value, PT, and FIB levels can all be used for predicting platelet transfusion bleeding in patients with immune thrombocytopenia. Their sensitivities were 80.0% (95% CI: 0.721, 0.843), 72.0% (95% CI: 0.683, 0.803), 80.0% (95% CI: 0.685, 0.803), 64.0% (95% CI: 0.602, 0.715), 72.0% (95% CI: 0.675, 0.796), and specificities were 81.1% (95% CI: 0.726, 0.861), 79.2% (95% CI: 0.764, 0.832), 86.8% (95% CI: 0.820, 0.892), and 77.4% (95% CI: 0.732, 0.863), respectively. 77.4% (95% CI: 0.721, 0.853).Conclusion The bleeding after platelet transfusion in patients with immune thrombocytopenia is closely related to K value, Angle, MA value, PT, and FIB levels, and should be closely monitored clinically.