不同疾病中血栓弹力图与凝血四项分析凝血功能的一致性分析(1)

不同疾病中血栓弹力图与凝血四项分析凝血功能的一致性分析【摘要】目的：分析比较不同疾病中血栓弹力图与凝血四项分析凝血功能的一致性。方法：收集2016年01月-2017年06月我院内分泌科、神经内科、消化内科、骨科、肿瘤内科进行治疗的糖尿病、脑出血、肝硬化、骨折、宫颈癌患者共283例，所有患者均进行凝血四项以及血栓弹力图检测，并采用全血细胞分析血小板计数判定患者的凝血功能，对上述两种诊断方法之间的一致性和相关性进行分析。结果：患者血栓弹力图及凝血四项检测的各指标测定值经K-S检验分析，均为非正态分布（P<0.05）。血栓弹力图与凝血四项检测的各项指标的相关性分析，PT与R值和α-Angle存在相关性，而与K 值和MA无关，与R值相关最明显；APTT与R值、α-Angle和MA相关，而与K值无关，与R值相关性最强；FIB与R值、K值、MA、α-Angle均具有相关性，其中与MA的相关性最强；Plt与K值、α-Angle、MA均相关，而与R值无关，与MA的相关性最强。血栓弹力图与凝血四项检测指标K值、MA、α-Angle及FIB之间存在一致性（Kappa=0.317、0.431、0.294，P＜0.05）；

K值、MA、α-Angle及Plt之间存在一致性（Kappa=0.384、0.356、0.213，P ＜0.05）；但ATPP、PT和R值之间不存在一致性（Kappa=0.057、0.036，P ＞0.05）。讨论：血栓弹力图与凝血四项检测之间具有显著的相关性，但二者的一致性较低，不能相互取替。因此，临床上应对患者进行血栓弹力图与凝血四项联合检测，进而提高临床凝血监测的科学性和准确性。

【关键词】凝血功能；血栓弹力图；凝血四项；一致性分析

Comparison of Consistency of Thrombelastogram and Four Coagulation Indexes in Analyzing the Coagulation Function in different diseases 【Abstract】Objective: To compare the consistency of thrombus elasticity and coagulation in four diseases. Methods: A total of 283 patients with diabetes mellitus, cerebral hemorrhage, cirrhosis, fractures and cervical cancer who were treated with endoscopy, neurology, gastroenterology, orthopedics and oncology were enrolled in this study. All patients were enrolled in this study. The coagulation function of the patients was determined by whole blood cell analysis and platelet count. The consistency and correlation between the two diagnostic methods were analyzed.

Results: The measured values of each group were analyzed by K-S test, which were non-normal distribution (P <0.05). There was a correlation between PT and R and α-Angle, but not with K value and MA, and the correlation between R and R was the most significant. The APTT and R value, α The correlation between FIB and R value, K value, MA and α-Angle is the strongest correlation with the K value, and the correlation with the R value is the strongest. Value, α-Angle, MA are related, and has nothing to do with the R value, and the strongest correlation with the MA. (Kappa = 0.317,0.431,0.294, P <0.05). The relati onship between K value, MA, α-Angle and FIB was significant (Kappa = 0.317,0.431,0.294, P <0.05); K value, MA, α-Angle and Plt (Kappa = 0.384,0.356,0.213, P <0.05); but there was no agreement between ATPP, PT and R (Kappa = 0.057,0.036, P> 0.05). Discussion: There is a significant correlation between thrombus elasticity and coagulation test, but the agreement between the two is low and can not be substituted for each other. Therefore, the clinical response to patients with thrombus elasticity and coagulation four joint detection, thereby improving the clinical coagulation monitoring of the scientific and accurate.

【key words】Coagulation function; Thrombelastogram; Four coagulation indexes; Consistency analysis

血栓和出血性风险检测一直是血液学研究的重要方向，众多疾病患者均应进行凝血功能的相关检测，及时发现血栓及出血等危险情况的存在，如糖尿病、脑出血、肝硬化、骨折、恶性肿瘤等等[1-3]。临床常用的患者凝血功能检测方法为血小板计数和凝血四项，其中凝血四项主要包括凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB），通过对上述指标的检测可以更详细的了解患者的凝血功能[4-5]，目前是血栓性疾病的首选筛查方法。血栓弹力图(thrombelastography，TEG)是一种反映血液凝固动态变化的新型指标，通过测试患者的全血样本的止凝血试验，主要参数包括凝血形成时间（K值）、凝血反应时间（R值）、最大振幅（MA）和凝固角（α-Angle），目前在临床中广泛应用于消化道出血、产后大出血、严重创伤等严重凝血功能障碍疾病患者的凝血功能判断[6-7]。血栓弹力图能够排除离心对血小板状态的影响，但在临床实际应用中尚未成熟，且与常规凝血实验的相关性和一致性有待进一步