标题：高出血风险患者血栓弹力图与常规凝血试验、血小板计数的相关性

      作者：王秀丽 1，雷芳 2，陈阿琴 1，汤郁 3，周小玉 4，费小明 1，2    (1.江苏大学附属医院输血科，江苏 镇江 212001；2.江苏大学附属医院血液科，江苏 镇江 212001；3.江苏大学附属医院风湿科，江苏 镇江 212001；4.南京医科大学第一附属医院输血科，江苏 南京 210029)

      卷次： 2018年29卷18期

      【摘要】 目的 研究血栓弹力图(TEG)在伴有血小板减少或常规凝血试验提示高出血风险患者中作用，并探讨TEG参数与常规凝血试验或血小板计数的相关性。方法 选取江苏大学附属医院2011-2015年间高出血风险患者712例，对患者TEG参数与常规凝血、血小板计数进行Pearson相关统计分析；分析各个亚群中TEG参数与血小板计数和常规凝血指标的相关性。结果 凝固时间(K)与纤维蛋白原(FBG)、血小板呈负相关(r=-0.790、-0.198)，与PT、APTT呈正相关(r=0.156、0.264)；α角与 PT、APTT呈负相关(r=-0.272、-0.440)，与血小板、FBG呈正相关(r=0.522、0.281)；CI与PT、APTT呈负相关(r=-0.264、-0.444)，与血小板、FBG呈正相关(r=0.457、0.232)；最大振幅(MA)与PT、APTT呈负相关(r=-0.234、-0.395)，与血小板、FBG呈正相关(r=0.615、0.333)；R值与 PT、APTT呈正相关(r=0.163、0.290)，与血小板呈负相关(r=-0.139)。其中，K值与FBG、α角与血小板、MA与血小板间具有中高度相关关系。在亚群分析中，血小板减少与R值、K值呈负相关(r=-0.131、-0.306)，与α角、CI、MA呈正相关(r=0.342、0.504、0.375)；APTT延长与R值、K值呈正相关(r=0.036、0.211)，与α角、CI、MA呈负相关(r=-0.330、-0.278、-0.322)；FBG降低与α角、CI呈正相关(r=0.413、0.503)；PT延长与R值呈正相关(r=0.243)。其中，只有血小板减少与CI及FBG降低与CI之间具有中度相关关系，余亚群间则相关关系较弱或无相关关系。结论 在有高出血风险的住院患者中，TEG部分参数与血小板计数和凝血试验结果有线性相关关系，在临床评估患者的出血风险时，联合TEG、血小板及常规凝血试验的结果可以更好地评估患者的出血风险。
      【关键词】 血栓弹力图；常规凝血试验；血小板；Pearson相关
      【中图分类号】 R55 【文献标识码】 A 【文章编号】 1003—6350（2018）18—2521—03

Correlation between thrombelastography and platelet count or conventional coagulation test in patients at highrisk for bleeding.
WANG Xiu-li 1, LEI Fang 2, CHEN A-qin 1, TANG Yu 3, ZHOU Xiao-yu 4, FEI Xiao-ming 1, 2. 1.Department of Transfusion, Affiliated Hospital of Jiangsu University, Zhanjiang 212001, Jiangsu, CHINA; 2. Department ofHematology, Affiliated Hospital of Jiangsu University, Zhanjiang 212001, Jiangsu, CHINA; 3. Department of Rheumatology,Affiliated Hospital of Jiangsu University, Zhanjiang 212001, Jiangsu, CHINA; 4. Department of Transfusion, First AffiliatedHospital of Nanjing Medical University, Nanjing 210029, Jiangsu, CHINA
【Abstract】 Objective To investigate the role of thrombelastogram (TEG) in evaluation of bleeding risk in pa-tients with abnormal conventional coagulation test and/or decreased platelet count, and also to anlyze the correlation be-tween TEG parameters and coagulation test and platelet count. Methods A total of 712 patients at high risk of bleedingfrom Affiliated Hospital of Jiangsu University between 2011 and 2015 was included in this study. Pearson test was em-ployed to investigate the correlation between TEG parameters and coagulation test and platelet count in total populationas well as each subpopulation. Results In the overall population, K were found to be conversely correlated with fibrino-gen (FBG) level and platelet count (r=-0.790, -0.198), while positively correlated with prothrombin time (PT) and acti-vated partial thromboplastin time (APTT) (r=0.156, 0.264). α-angle was found to be conversely correlated with PT andAPTT (r=-0.272, -0.440), and positively correlated with platelet and FBG (r=0.522, 0.281). CI value was found to beconversely correlated with PT and APTT (r=-0.264,-0.444), and positively correlated with platelet and FBG (r=0.457,0.232). Maximum amplitude (MA) value was found to be conversely correlated with PT and APTT (r=-0.234, -0.395),and positively correlated with platelet and FBG (r=0.615, 0.333). R value was found to be conversely correlated withplatelet (r=-0.139), and positively correlated with PT and APTT (r=0.163, 0.290). For all those relationships, K valueand FBG, α-angle and platelet count as well as MA value and platelet count were moderately or highly correlated. In the·论 著·doi:10.3969/j.issn.1003-6350.2018.18.002基金项目：国家自然科学基金面上项目(编号：81571582)；江苏省卫生计生委医学科研课题(编号：Z 201512)