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中华老年病研究电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 7 -11. doi: 10.3877/cma.j.issn.2095-8757.2020.03.002

所属专题: 总编推荐 文献

论著

血栓弹力图对老年重症患者深静脉血栓形成的预测价值
沈鹏1, 王倩倩1, 顾逸晨1, 戴靓潇1, 吴莉菁1, 施云超1,()   
  1. 1. 314001 嘉兴市第一医院重症医学科
  • 收稿日期:2020-03-26 出版日期:2020-08-28
  • 通信作者: 施云超
  • 基金资助:
    浙江省医药卫生科研项目(2016ZYC-A73)

Predictive value of thromboelasmogram for deep venous thrombosis in elderly patients with severe disease

Peng Shen1, Qianqian Wang1, Yichen Gu1, Liangxiao Dai1, Lijin Wu1, Yunchao Shi1,()   

  1. 1. Department of Critical Care Medicine, the First Hospital of Jiaxing, Jiaxing 314001, China
  • Received:2020-03-26 Published:2020-08-28
  • Corresponding author: Yunchao Shi
  • About author:
    Corresponding author: Shi Yunchao, Email:
引用本文:

沈鹏, 王倩倩, 顾逸晨, 戴靓潇, 吴莉菁, 施云超. 血栓弹力图对老年重症患者深静脉血栓形成的预测价值[J/OL]. 中华老年病研究电子杂志, 2020, 07(03): 7-11.

Peng Shen, Qianqian Wang, Yichen Gu, Liangxiao Dai, Lijin Wu, Yunchao Shi. Predictive value of thromboelasmogram for deep venous thrombosis in elderly patients with severe disease[J/OL]. Chinese Journal of Geriatrics Research(Electronic Edition), 2020, 07(03): 7-11.

目的

探讨血栓弹力图(thrombelastogram, TEG)对老年重症患者深静脉血栓(deep vein thrombosis, DVT)形成的预测价值。

方法

选取2017年2月至2018年5月嘉兴市第一医院收治的59例老年重症患者作为研究对象,收集其入院1、3、5、7 d的静脉血,记录TEG和常规凝血试验(conventional coagulation test, CCT)的检测结果。采用t检验/秩和检验或χ2检验比较DVT组与非DVT组患者TEG和CCT各指标的差异。采用ROC曲线评价TEG与CCT各项指标对老年重症患者DVT的预测价值。

结果

CCT检测结果显示,DVT组与非DVT组仅D-二聚体水平的差异有统计学意义(t=2.345,P<0.05);TEG检测结果显示,DVT组凝集块形成速度、最大振幅、综合凝血指数均明显高于非DVT组,差异有统计学意义(t=2.151、2.614,F=13.750;P<0.05);两组患者仅入院第5天的最大振幅差异有统计学意义(P<0.05)。ROC曲线分析结果可见临床预测DVT价值较好的指标依次为最大振幅、凝集块形成速度、综合凝血指数和D-二聚体,其敏感度分别为94.4%、50.0%、44.4%、95.1%,特异度分别为48.8%、85.4%、85.4%、33.3%,ROC曲线下面积分别为0.762、0.662、0.656、0.651。入ICU第5天最大振幅为67.5,是预测DVT发生的最佳临床诊断界值。

结论

TEG预测老年重症患者DVT发生的准确性高于常规凝血试验指标。

Objective

To the predictive value of TEG for formation of Deep vein thrombosis (DVT) in elderly patients with severe thrombelastogram.

Methods

59 elderly critically patients admitted to Jiaxing First Hospital from February 2017 to May 2018 were selected, venous blood samples were collected on the 1st, 3rd, 5th and 7th day after admission, and the results of TEG and CCT were recorded. TEG and CCT indexes were compared between DVT group and non DVT group by T-test/rank sum test or chi-square test. ROC curve was used to evaluate the predictive value of TEG and CCT for DVT in elderly patients with severe diseases.

Results

The results of CCT showed that the difference of D-dimer (D-D) level between DVT group and non DVT group was statistically significant (t=2.345, P < 0.05); the results of TEG test showed that the formation speed, maximum amplitude and coagulation index of DVT group were significantly higher than those of non DVT group (t=2.151, 2.614; F=13.750; P < 0.05); and the maximum amplitude difference between the two groups was statistically significant only on the 5th day after admission (P < 0.05). According to the ROC curve analysis results, the indicators that are good at predicting the value of DVT clinically include maximum amplitude, agglutination velocity, coagulation index and D-D, the sensitivity is 94.4%, 50.0%, 44.4% and 95.1%, specificity is 48.8%, 85.4%, 85.4% and 33.3%, respectively, and area under the ROC curve is 0.762, 0.662, 0.656 and 0.651, respectively. Ma was 67.5 on the 5th day after admission into ICU, which was the best clinical diagnostic cut-off value for DVT.

Conclusion

The accuracy of TEG in predicting DVT in elderly critically patients was higher than that of CCT.

表1 两组患者一般资料的比较
表2 DVT组与非DVT组CCT检测指标的比较(±s
表3 DVT组与非DVT组TEG检测指标的比较
图1 D-二聚体与血栓弹力图检测诊断深静脉血栓的ROC曲线分析
表4 D-二聚体与TEG检测指标预测深静脉血栓的临床诊断评价
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