Application of thromboelastography in patients with inflammatory bowel disease or colorectal polyps
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摘要: 目的 了解炎症性肠病(IBD)和结直肠息肉患者凝血功能的变化规律，探讨血栓弹力图(TEG)在评价两类患者凝血功能中的监测价值。方法 回顾性分析2021年1月—2022年12月在医院就诊的50例IBD患者和85例结直肠息肉患者TEG的凝血反应时间(R)、凝血凝固时间(K)、凝血形成速率(Angle)、凝血最终强度(MA)参数，以139例健康体检者的参数作为对照组，观察各组相关指标的差异。另将患者组的TEG参数与常规凝血指标：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-Dimer)、纤维蛋白原(Fib)进行相关性分析。结果 IBD患者与对照组比较，R和K均显著降低；MA显著升高(P＜0.05)。在结直肠息肉患者中，R、K和Angle小于对照组；而MA大于对照组，差异有统计学意义(P＜0.05)。Spearman相关性分析结果显示，IBD患者的R与APTT、TT呈正相关；K与TT呈正相关，与Fib和D-Dimer呈负相关；Angle与TT、D-Dimer呈负相关, 与Fib呈正相关；而MA与Fib、D-Dimer均呈正相关(P＜0.05)。结直肠息肉患者的R与APTT呈显著正相关；K与APTT、TT呈显著正相关；MA与Fib呈显著正相关，均具有线性关系(P＜0.05)。结论 TEG在IBD和结直肠息肉患者凝血状态监测中均具有重要的临床意义。TEG和常规凝血功能试验在两类疾病凝血功能评估中可相互补充，不可相互取代。Abstract: Objective To investigate the changes of coagulation function in patients with inflammatory bowel disease(IBD) or colorectal polyps, and evaluate the value of thromboelastography(TEG) in monitoring coagulation function.Methods The parameters of TEG, including reaction time(R), clot kinetics(K), clot strengthening(Angle), maximum amplitude(MA), were retrospectively analyzed in 50 patients with IBD and 85 patients with colorectal polyps treated in hospital from January 2021 to December 2022, and these parameters of 139 healthy subjects were used as the control group. In addition, the correlation between TEG parameters and conventional coagulation indexes, such as thrombin time(TT), activated partial thromboplastin time (APTT), prothrombin time(PT), D-Dimer and fibrinogen (Fib) was analyzed.Results Compared with the control group, the R and K of IBD patients were significantly decreased, MA was significantly increased(P＜0.05). In colorectal polyp patients, R, K and Angle were smaller than those in control group, and the MA was higher than that of the control group, with statistical significance(P＜0.05). Spearman correlation analysis showed that R was positively correlated with APTT and TT in IBD patients, K was positively correlated with TT, and negatively correlated with Fib and D-Dimer. Angle was negatively correlated with TT and D-Dimer, but positively correlated with Fib. MA was also positively correlated with Fib and D-Dimer(P＜0.05). In colorectal polyp patients, there was a significant positive correlation between R and APTT, K was positively correlated with APTT and TT, and there was significant positive correlation between MA and Fib, all had linear relationship(P＜0.05).Conclusion TEG may play an important role in monitoring coagulation status in the patients with IBD or colorectal polyps. TEG and conventional coagulation tests can complement each other but not replace each other in the assessment of coagulation function in the two diseases.
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表 1 3组一般资料比较
组别 例数 性别/例 男/女 年龄/岁 男 女 对照组 139 95 44 2.16 24~81 IBD组 50 33 17 1.94 20~88 结直肠息肉组 85 56 29 1.93 33~64 
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表 2 TEG参数描述统计
组别 例数 R/min K/min Angle/° MA/mm 对照组 139 6.8(6.1~7.6) 2.2(1.9~2.5) 66.7(63.6~69.0) 58.4(55.8~60.4) IBD组 50 5.7(4.9~6.2)1) 1.5(1.2~1.8)1) 67.7(58.8~72.1) 65.3(60.6~70.2)1) 结直肠息肉组 85 5.2(4.7~6.0)1) 1.7(1.4~2.0)1) 62.5(58.0~68.1)1) 63.7(59.7~67.2)1) 与对照组比较，1)P＜0.05。
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表 3 IBD患者TEG参数与常规凝血指标相关性分析
参数 R K Angle MA r P r P r P r P PT 0.051 0.725 -0.146 0.311 0.014 0.922 0.085 0.558 APTT 0.358 0.011 0.061 0.675 -0.109 0.452 0.078 0.588 TT 0.399 0.004 0.422 0.002 -0.419 0.002 -0.374 0.007 Fib 0.104 0.471 -0.560 ＜0.001 0.543 ＜0.001 0.575 ＜0.001 D-Dimer -0.137 0.343 -0.507 ＜0.001 -0.525 ＜0.001 0.446 0.001
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表 4 结直肠息肉患者TEG参数与常规凝血指标相关性分析
参数 R K Angle MA r P r P r P r P PT 0.069 0.529 0.070 0.526 0.132 0.227 -0.033 0.765 APTT 0.357 0.001 0.239 0.027 -0.131 0.232 -0.107 0.332 TT 0.209 0.055 0.238 0.028 0.058 0.600 -0.124 0.259 Fib 0.146 0.186 -0.209 0.057 0.190 0.084 0.253 0.020 D-Dimer -0.011 0.921 -0.084 0.446 -0.260 0.816 0.132 0.229
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