Value of thromboelastography in predicting PVT after splenectomy for cirrhotic portal hypertention
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摘要: 目的：探究血栓弹力图（TEG）在肝硬化门静脉高压（CPH）脾切除患者术后门静脉血栓形成（PVT）中的预测价值。方法：选取2017年2月—2020年4月行CPH脾切除术后PVT患者80例为观察组，同期术后无PVT患者80例为对照组进行回顾性分析。统计2组一般资料、术后1 d、3 d、5 d凝血功能指标[凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）、纤维蛋白原（FIB）]，TEG参数[凝血反应时间（R值）、凝血凝固时间（K值）、凝血形成速率（α角）、凝血最终强度（MA）]，应用Pearson相关性分析探讨TEG参数与CPH脾切除术后PVT患者凝血功能的相关性，Logistic回归分析探讨各时间点TEG参数与CPH脾切除术后PVT的关系，探究TEG参数对CPH脾切除术后PVT的预测价值。结果：观察组术后1 d、3 d、5 d TT、APTT、PT水平低于对照组，D-D、FIB水平高于对照组（P<0.05）。观察组术后1 d、3 d、5 d K、R低于对照组，α角、MA高于对照组（P<0.05）。Pearson相关性分析发现，K、R与CPH脾切除术后PVT患者TT、APTT、PT呈正相关，与D-D、FIB水平呈负相关（P<0.05）；α角、MA与CPH脾切除术后PVT患者TT、APTT、PT呈负相关，与D-D、FIB水平呈正相关（P<0.05）。Logistic回归分析发现，术后1 d、3 d、5 d的K、R、α角、MA是CPH脾切除患者术后PVT发生的重要影响因素（P<0.05）。术后5 d K、R、α角、MA联合预测CPH脾切除患者术后PVT的ROC曲线下面积为0.868，敏感性、特异性分别为83.75%、80.00%。结论：TEG可作为了解CPH脾切除术患者术后高凝状态、预测PVT发生高风险、指导临床针对性治疗的检测项目。Abstract: Objective: To explore the predictive value of thromboelastography(TEG) in portal vein thrombosis(PVT) after splenectomy in patients with cirrhotic portal hypertention(CPH).Methods: From February 2017 to April 2020, 80 patients with PVT after CPH splenectomy in our hospital were selected as the observation group, and 80 patients without PVT after operation during the same period were selected as the control group for retrospective analysis. The general data, coagulation function indexes(thrombin time[TT], activated partial thromboplastin time[APTT], prothrombin time[PT], D-dimer[DD], fibrinogen[FIB]), and TEG parameters(coagulation reaction timeR value, coagulation time[K value], coagulation rate[α angle], final coagulation strength[MA])at 1 d, 3 d, and 5 d after the operation of the two groups were counted. Pearson correlation analysis was used to explore the correlation between TEG parameters and coagulation function of PVT patients after CPH splenectomy. The relationship between TEG parameters and PVT after CPH splenectomy was analyzed by Logistic regression analysis, and the predictive value of TEG parameters for PVT after CPH splenectomy was explored.Results: The levels of TT, APTT, and PT in the observation group were lower than those in the control group at 1 d, 3 d, and 5 d after surgery, and the levels of D-D and FIB were higher than those of the control group(P<0.05). K and R of observation group were lower than those of control group at 1 d, 3 d, 5 d after operation, α angle and MA were higher than those of control group(P<0.05). Pearson correlation analysis found that K and R were positively correlated with TT, APTT, and PT in PVT patients after CPH splenectomy, and negatively correlated with D-D and FIB levels(P<0.05). α angle and MA were negatively correlated with TT, APTT, and PT in PVT patients after CPH splenectomy, and positively correlated with D-D and FIB levels(P<0.05). Logistic regression analysis found that K, R, α angle and MA at 1 d, 3 d, 5 d postoperatively were important influencing factors of PVT after CPH splenectomy(P<0.05). The area under the ROC curve(AUC) of the combined prediction of K, R, α angle, and MA in patients with CPH splenectomy at 5 d after the operation was 0.868, and the sensitivity and specificity were 83.75% and 80.00%, respectively.Conclusion: TEG can be used as a test item to understand the postoperative hypercoagulability of patients with CPH splenectomy, predict the high risk of PVT and guide clinical targeted treatment.
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