血栓弹力图在重度血小板减少者中的应用

目的 研究重度血小板减少患者血栓弹力图指标与出血的关系.方法 根据临床诊断将108例血小板小于20×109/L的患者分为出血组和不出血组,并对他们的血小板计数及血栓弹力图检测结果差异进行统计学分析.结果 重度血小板减少时,两组患者的性别、年龄、血小板减少类型、凝血象(凝血酶原时间、活化部分凝血酶原时间、凝血酶时间、纤维蛋白原)及血栓弹力图参数中的反应时间、凝固时间、血凝块聚合速度、凝血综合指数、LY30(反映纤溶活性)差异无统计学意义(P>0.05),但出血组的血小板及血栓弹力图参数中的血栓最大幅度(MA)值明显低于不出血组(P<0.01),采用Logistic回归以及ROC曲线分析得到出血=1.253-0.13血小板-0.042 MA,界值点取-1.478 5时,灵敏度、特异度分别为0.667、0.833,且大于该值的患者有93.3%的可能会出血.结论 血栓弹力图指标中的MA值在预测重度血小板减少患者的出血倾向时有重要作用.

Application of thrombelastogram monitoring in patients with severe thrombocytopenia

Objective To study the relationship between thrombelastography variables and hemeorrhage in patients with severe thrombocytopenia.Methods Accroding to clinical diagnosis,108 patients whose thrombocyte were less than 20×109/L,were devided into bleeding group and non-bleeding group.Then we compared them with the results of platelet count and thrombelastography.Results In the patients with severe thrombocytopenia,the study showed that there was no significant differences between the two groups about their gender,age,the types of thrombocytopenia,PT,APTT,TT,Fib and partial parameters of thrombelastograph,including response time,coagulation time,coagulation rate,comprehensive index,LY30（P〈0.05）.However the platelet count and MA in hemorrhage group were obviously lower than those of the non-hemorrhage group（P〈0.01）.Resulting from Logistic regression analysis and ROC study,we got bleeding equal to 1.253-0.13 PLT-0.042 MA,whose cut off point was-1.478 5,sensitivity was 0.667,and specificity was 0.833.If the patients′ point was higher than-1.478 5,93.3% of them would bleed.Conclusion MA,one variable of thrombelastography,is helpful in predicting bleeding in patients with severe cthrombocytopenia.