血栓弹力图在评估肝硬化患者凝血状态中的作用-东南大学学报医学版

血栓弹力图在评估肝硬化患者凝血状态中的作用

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院消化科, 江苏南京 210009

分类号：R575.2

出版年·卷·期（页码）：2016·35·第二期（215-219）

摘要：

目的:探讨血栓弹力图(TEG)在判断肝硬化失代偿期患者出血或血栓形成风险中的作用,以用于指导临床治疗。方法:选择80例确诊为肝硬化失代偿期(Child C级)的患者为观察对象,同时选择无肝胆疾病及血液系统疾病、未使用干扰凝血药物、肝功能正常者26例作为对照组。所有患者均检测血常规、常规凝血指标及TEG,并根据临床表现、腹部CT血管造影(CTA)及下肢静脉血管超声检查结果,统计肝硬化失代偿期患者出血及血栓形成的情况。结果:肝硬化失代偿期出血及无出血患者TEG检测参数中,α角、MA、CI均较对照组显著降低,K值明显延长,R值有缩短趋势;与肝硬化失代偿期无出血患者相比,肝硬化失代偿期出血患者的α角、MA、CI明显降低,提示其低凝较为明显;两组之间反映纤溶的指标LY30比较,差异无统计学意义(P>0.05)。在肝硬化失代偿期出血患者中,合并血栓组的α角明显高于无合并血栓组。在肝硬化失代偿期无出血患者中,合并血栓组与无合并血栓组比较,TEG的各项参数差异无统计学意义(P>0.05)。结论:TEG可作为判断肝硬化失代偿期患者凝血状态的临床指标,用于指导临床成分性输血治疗,是降低出血风险的手段之一。

Objective:To investigate the effect of thromboelastography(TEG) in judging the risk of bleeding or thrombosis in patients with decompensated cirrhosis in order to guide clinical treatment. Methods:Eighty patients with decompensated cirrhosis(Child class C) and 26 cases of normal liver function not receiving drugs interfered with blood clotting, without blood abnormalities and hepatobiliary disorders were enrolled. TEG, conventional coagulation examinations and blood routine tests were examined respectively. In addition, according to the clinical manifestations, abdominal CT angiography and veins ultrasonic examination in lower limbs, cases of hemorrhage and thrombosis in patients with decompensated cirrhosis were calculated. Results:The result of TEG showed that α angle, MA and CI were significantly lower in both hemorrhage patients and non-hemorrhage patients with decompensated cirrhosis compared with control, meanwhile K value increased and R value decreased. Compared with non-hemorrhage patients, α angle, MA and CI were lower, hypocoagulable state were more obvious in hemorrhage patients. But there were no significant difference in LY30 between them(P>0.05). In hemorrhage group, the result of TEG showed that α angle were higher in patients with thrombosis than patients without thrombosis. In patients with non-hemorrhage, there was no statistical significance in TEG parameters between thrombosis group and non-thrombosis group(P>0.05). Conclusion:TEG can be used as clinical indexs to judge coagulation states in patients with decompensated cirrhosis, and to guide clinical treatment for component blood transfusion. It is one of means to reduce the risk of bleeding.

参考文献：

[1] LANCÉM D.A general review of major global coagulation assays:thrombelastography,thrombin generation test and clot waveform analysis[J].Thromb J,2015,13:1.
[2] 卢尧,滕方,孙桂香,等.肝硬化患者凝血障碍机制研究进展[J].中国输血杂志,2015,28(2):216-220.
[3] IWAKIRI Y.Pathophysiology of portal hypertension[J].Clin Liver Dis,2014,18(2):281-291.
[4] ROBERTS L N,BERNAL W.Management of bleeding and thrombosis in critically Ⅲ patients with liver disease[J].Semin Thromb Hemost,2015,41(5):520-526.
[5] 胡晓,冯立民,王佳丽.肝硬化患者血浆凝血因子Ⅷ及常规凝血指标检测结果分析[J].实验与检验医学,2013,31(1):24-26.
[6] TAPPER E B,ROBSON S C,MALIK R.Coagulopathy in cirrhosis-the role of the platelet in hemostasis[J].J Hepatol,2013,59(4):889-890.
[7] HOFFMAN M.Coagulation in liver disease[J].Semin Thromb Hemost,2015,41(5):447-454.
[8] Da LUZ L T,NASCIMENTO B,SHANKARAKUTTY A K,et al.Effect of thromboelastography(TEG^®) and rotational thromboelastometry(ROTEM^®) on diagnosis of coagulopathy,transfusion guidance and mortality in trauma:descriptive systematic review[J].Critical Care,2014,18(5):518.
[9] 蔡毅,崔华,范利.血栓弹力图研究进展概况[J].中华老年心脑血管病杂志,2014,16(11):1217-1218.
[10] 吴接玉,田明,李丹丹,等.血栓弹力图在早期肝硬化患者凝血功能状态评估中的作用[J].现代仪器与医疗,2014,20(6):39-40.
[11] GARBER J,ROSE A,VIESSELMANN C,et al.Evaluation of thromboelastography for venous thromboembolism prophylaxis in liver failure patients[J].Crit Care Med,2015,43(12):151.
[12] De PIETRI L,BIANCHINI M,MONTALTI R,et al.Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy.A randomized controlled trial[J/OL].Hepatology,2016,63(2):566-573.
[13] STRAVITZ R T.Potential applications of thromboelastography in patients with acute and chronic liver disease[J].Gastroenterol Hepatol(N Y),2012,8(8):513-520.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录