Study on correlation between thromboelastography and routine coagulation test in evaluation of coagulability in elderly fracture patients
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摘要: 目的 比较临床中评估老年骨折患者凝血状态的常用方法，探讨血栓弹力图(TEG)与常规凝血试验判断高凝状态的相关性及一致性。方法 收集2021年同时检测TEG与常规凝血试验的老年骨折患者290例为试验组，同期100例健康人作为对照组。检测2组的TEG参数与常规凝血指标进行相关性及一致性分析比较。结果 试验组与对照组的凝血凝固时间(K)、凝血形成速率(α角)、凝血最终强度(MA)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)比较差异有统计学意义(P < 0.05)。TEG检测与常规凝血功能检测相关性分析表明，老年骨折患者的TEG参数中凝血反映时间(R)与凝血酶原时间(PT)呈正相关(r=0.314，P < 0.05)，与FIB呈负相关(r=-0.142，P < 0.05)；K与PT、TT呈正相关(r分别为0.201、0.184，P < 0.05)，与FIB呈负相关(r=-0.589，P < 0.05)；α角与FIB呈正相关(r=0.597，P < 0.05)，与PT、TT呈负相关(r分别为-0.200、-0.171，P < 0.05)；MA与APTT呈正相关(r=0.122，P < 0.05)，与PT、TT呈负相关(r分别为-0.130、-0.201，P < 0.05)。此外，R与APTT、PT的χ2结果分别为0.26(P>0.05)、0.64(P < 0.05)。FIB与α角、MA、R的χ2结果分别为0.32(P>0.05)、37.35(P < 0.05)、82.29(P < 0.05)。结论 老年骨折患者的凝血状态与健康人群存在差异，TEG参数、常规凝血试验指标之间存在相关性，但一致性较弱，无法相互替代。在今后的临床实践中，可综合运用TEG与常规凝血试验，有助于更加准确、及时地判断老年骨折患者的高凝状态，合理使用抗凝药物。Abstract: Objective To compare the common methods used in clinical evaluation of coagulation status in elderly fracture patients, and explore the correlation and consistency between thrombelastogram(TEG) and conventional coagulation tests to determine hypercoagulant status.Methods A total of 290 elderly fracture patients who were tested in the hospital in 2021 for both TEG and conventional coagulation tests were collected as the experimental group, and 100 healthy people's TEG and routine coagulation test results were collected as the healthy control group during the same period. The correlation and consistency analysis of the TEG parameters detected by the two groups of personnel were compared with conventional coagulation indicators.Results The comparison of K-values, α angle, MA, APTT, TT, and FIB in the experimental group and the healthy control group was statistically significant(P < 0.05). The correlation analysis between TEG detection and conventional coagulation function test showed that the R value in the TEG parameters of elderly fractured patients was positively correlated with PT(r=0.314, P < 0.05) and negatively correlated with FIB(r=-0.142, P < 0.05). The K value was positively correlated with PT and TT(r=0.201, 0.184, P < 0.05, respectively), and negatively correlated with FIB(r=-0.589, P < 0.05). The α angle was positively correlated with FIB(r=0.597, P < 0.05) and negatively correlated with PT and TT(r=-0.200, -0.171, P < 0.05, respectively). MA was positively correlated with APTT(r=0.122, P < 0.05) and negatively correlated with PT and TT(r=-0.130, -0.201, P < 0.05, respectively). In addition, the chi-square test results of R-value and APTT and PT were χ2=0.26(P>0.05) and χ2=0.64(P < 0.05), respectively. The chi-square tests for FIB and α angle, MA, and R were χ2=0.32(P>0.05), χ2=37.35(P < 0.05), and χ2=82.29(P < 0.05), respectively.Conclusion There were differences between the coagulation status of elderly fracture patients and healthy people, and there was a correlation between TEG parameters and conventional coagulation test indicators, but the consistency was weak and could not be replaced by each other. In future clinical practice, the combined use of TEG and conventional coagulation tests can help to more accurately and timely judge the hypercoagulable state of elderly fracture patients and rationally use anticoagulant drugs.
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表 1 2组常规凝血检测和TEG检测结果
X±S 指标 对照组
(n=100)试验组
(n=290)t P R/s 36.18±4.83 34.64±6.85 -1.66 0.098 K/s 65.58±14.18 48.44±2.67 -1.98 0.048 α角/deg 76.09±2.41 81.31±1.55 5.67 ＜0.001 MA/mm 61.99±3.47 71.64±3.12 4.74 ＜0.001 APTT/s 31.05±3.33 31.76±5.61 -2.35 0.020 PT/s 11.99±0.79 12.30±1.83 1.51 0.131 TT/s 16.84±0.77 16.08±0.94 -2.77 0.006 FIB/(g·L-1) 2.84±0.67 4.97±1.19 6.17 ＜0.001 
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表 2 试验组TEG参数与常规凝血指标
指标 均值 百分位数 最大值 最小值 参考值 25% 50% 75% R/s 34.98 30.60 32.40 38.10 66.60 21.60 22.00~44.00 K/s 60.01 48.00 48.00 63.15 334.20 48.00 34.00~138.00 α角/deg 78.41 80.45 81.50 82.35 85.40 76.20 64.00~80.00 MA/mm 65.09 64.78 69.80 71.40 80.80 64.90 52.00~71.00 APTT/s 30.02 28.15 30.70 34.85 50.60 23.20 24.00~39.00 PT/s 12.21 11.60 12.00 12.70 27.70 10.30 10.00~14.00 TT/s 16.48 15.40 16.00 16.70 18.70 14.20 14.00~21.00 FIB/(g·L-1) 3.82 4.12 4.97 5.74 8.12 2.35 2.00~4.00
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表 3 试验组TEG参数与常规凝血指标的相关性
指标 R K α角 MA r P r P r P r P APTT 0.377 ＜0.001 -0.079 0.431 0.017 0.868 -0.032 0.751 PT 0.264 0.008 0.041 0.685 -0.128 0.201 -0.171 0.088 TT -0.157 0.116 -0.155 0.123 0.251 0.011 0.213 0.033 FIB 0.136 0.174 -0.005 0.964 0.013 0.895 0.067 0.503
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表 4 试验组R与APTT、PT的χ2检验
例 R APTT PT 高凝 非高凝 合计 高凝 非高凝 合计 高凝组 1 9 10 1 9 10 非高凝组 6 274 280 5 275 280 合计 7 283 290 6 284 290
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表 5 试验组FIB与α、MA、R的χ2检验
例 FIB α角 MA R 高凝 非高凝 合计 高凝 非高凝 合计 高凝 非高凝 合计 高凝 69 37 106 38 68 106 2 104 106 非高凝 42 142 184 13 171 184 8 176 184 合计 111 179 290 51 239 290 10 280 290
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