血栓弹力图参数及PLT、PDW、MPV、P-LCR水平与多发性创伤患者严重程度的相关性分析

Associations of thromboelastography parameters, PLT, PDW, MPV and P-LCR with injury severity in polytrauma patients

摘要:

目的 探究血栓弹力图（TEG）参数及血小板计数（PLT）、血小板分布宽度（PDW）、平均血小板容积（MPV）、大血小板比率（P-LCR）等血小板相关指标与多发性创伤患者严重程度的相关性。方法 回顾性分析2021年1月—2023年12月延安大学咸阳医院收治的117例多发性创伤患者，根据损伤严重程度评分（ISS）将患者分为轻症组（64例，ISS<16分）和重症组（53例，ISS评分≥16分），另取同期该院40例健康体检人群为对照组。比较3组TEG参数［凝固反应时间（R值）、凝血速率（K值）、水平夹角（α角）及最大振幅（MA值）］及血小板相关指标（PLT、PDW、MPV、P-LCR）。通过Spearman相关性分析评估TEG参数及PLT、PDW、MPV、P-LCR水平与多发性创伤患者严重程度的相关性。根据患者预后情况分为存活组和死亡组，比较两组TEG参数，并通过受试者工作特征（ROC）曲线分析其对预后的预测效能。结果 轻症组R值、K值均高于对照组（P <0.05），α角、MA值均低于对照组（P <0.05）；重症组R值、K值均高于轻症组和对照组（P <0.05），α角、MA值均低于轻症组和对照组（P <0.05）。轻症组PLT、PDW、MPV、P-LCR均高于对照组（P <0.05）；重症组PLT、PDW、MPV、P-LCR均高于轻症组和对照组（P <0.05）。Spearman相关性分析结果显示，R值（r_s =0.399）、K值（r_s =0.544）、PDW（r_s =0.594）、MPV（r_s =0.581）、P-LCR（r_s =0.649）与多发性创伤患者的严重程度均呈正相关（P <0.05）；α角（r_s =-0.709）、MA值（r_s =-0.597）、PLT（r_s =-0.597）与多发性创伤患者的严重程度均呈负相关（P <0.05）。死亡组R值、K值均高于存活组（P <0.05），α角、MA值均低于存活组（P <0.05）。TEG参数联合血小板相关指标检测预测多发性创伤患者预后的敏感性为97.1%（95% CI：0.881，0.981），特异性为96.3%（95% CI：0.740，0.955），曲线下面积为0.984（95% CI：0.961，1.000）。结论 在多发性创伤患者中，TEG参数及PLT、PDW、MPV、P-LCR水平与严重程度相关，可作为患者预后评估的检测指标。

Abstract:

Objective To investigate the associations of thromboelastography (TEG) parameters and platelet indices including platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet large cell ratio (P-LCR) with injury severity in polytrauma patients.Methods We retrospectively analyzed 117 patients with polytrauma admitted to Xianyang Hospital of Yan’an University from January 2021 to December 2023. They were categorized into a mild group (64 cases, ISS < 16 points) and a severe group (53 cases, ISS ≥ 16 points). Additionally, 40 healthy individuals undergoing routine examinations during the same period were selected as the control group. TEG parameters [reaction time (R value), kinetics time (K value), horizontal angle (α angle), and maximum amplitude (MA value) ] and platelet indices (PLT, PDW, MPV, P-LCR) were compared across the three groups. Spearman correlation analysis was used to assess the relationships between TEG parameters and the levels of PLT, PDW, MPV, and P-LCR with the severity of polytrauma. Patients were classified into survival and death groups based on clinical outcomes, and the two groups were compared in terms of their TEG parameters. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of these parameters for patient prognosis.Results The mild group exhibited higher R and K values than the control group (P < 0.05), while the α angle and MA value were lower in the mild group than in the control group (P < 0.05). The severe group demonstrated higher R and K values than both the mild group and the control group (P < 0.05), whereas the α angle and MA value were lower in the severe group than in the other two groups (P < 0.05). The mild group had higher PLT, PDW, MPV and P-LCR than the control group (P < 0.05), and the severe group had even higher PLT, PDW, MPV and P-LCR than both the mild group and the control group (P < 0.05). Spearman correlation analysis revealed that the R value (r_s = 0.399), K value (r_s = 0.544), PDW (r_s =0.594), MPV (r_s = 0.581), and P-LCR (r_s = 0.649) were positively correlated with the severity of polytrauma (P < 0.05), and that the α angle (r_s = -0.709), MA value (r_s = -0.597), and PLT (r_s = -0.597) were negatively correlated with the severity of polytrauma (P < 0.05). The R value and K value were higher in the death group than in the survival group (P < 0.05), while the α angle and MA value were lower in the death group than in the survival group (P < 0.05). The combination of TEG parameters and platelet indices for prognostic assessment of patients with polytrauma demonstrated a sensitivity of 97.1% (95% CI: 0.881, 0.981), a specificity of 96.3% (95% CI: 0.740, 0.955), and an AUC of 0.984 (95% CI: 0.961, 1.000).Conclusion In patients with polytrauma, TEG parameters and levels of PLT, PDW, MPV, and P-LCR correlate with injury severity and may serve as indicators for assessing patient prognosis.