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摘要: 目的 探讨老年人血栓弹力图(TEG)的特点，以便更全面准确地对老年性疾病进行指导。方法 回顾性分析2021年1月—2022年12月医院体检科健康老年人，年龄60~83岁，用北京乐普公司TEG仪进行检测，并对其凝血形成速率(α角)、血凝块溶解百分比(EPL)、凝血反应时间(R)、凝血形成时间(K)、凝血最大强度(MA)、凝血综合指数(CI)、纤维蛋白溶解指数(LY30)和血凝块力学强度(G)等数据进行统计分析。结果 与厂家提供的TEG参考值比较，老年人的α角、G值偏大，LY30、EPL明显减小，差异有统计学意义(P < 0.05)；将健康老年人的TEG参数与健康年轻人比较，除R和G以外，其余各参数之间差异有统计学意义(P < 0.05)。结论 老年人的TEG参考区间与厂商提供及健康年轻人的参考区间存在差异，应根据人群特点制定相应的参考范围指导临床。Abstract: Objective To explore the characteristics of the elderly's thrombelastogram in order to provide more comprehensive and accurate guidance for geriatric diseases.Methods Retrospective analysis of Healthy elderly people aged 60-83 were selected from January 2021 to December 2022 at our Hospital. Thromboelastography instruments from Leopold Company in Beijing were used for testing, and statistical analysis was conducted on parameters such as clotting angle(α-angle), clot formation time(K), maximum amplitude(MA), clotting reaction time(R), clotting index(CI), predicted clot dissolution percentage(EPL), fibrinolysis index(LY30), and clot mechanical strength(G).Results Compared with the reference values provided by the manufacturer, the α angle and G value in elderly individuals were higher, while LY30 and EPL were significantly reduced, with statistical significance(P < 0.05). Comparing the thromboelastography parameters of healthy elderly individuals with those of healthy young individuals, except for R and G, there were statistically significant differences among the other parameters.Conclusion There were differences between the reference ranges of thromboelastography in elderly individuals, the ranges provided by the manufacturer, and those of healthy young individuals. Therefore, appropriate reference ranges should be established based on population characteristics to guide clinical practice.
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Key words:
- thrombelastogram /
- elderly /
- characteristics
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表 1 老年人TEG各参数的参考范围及其与厂家参考区间的比较
类型 老年人平均水平 老年人参考区间 厂家参考值 不在老年人范围例数/例 在老年人范围例数/例 不在厂家范围例数/例 在厂家范围例数/例 χ2 P α角/° 64.20±6.47 51.50~76.88 53.00~72.00 22 443 68 397 26.03 < 0.001 K/min 1.80±0.56 0.70~2.90 1.00~3.00 180 447 20 445 0.11 0.869 MA/mm 62.23±5.41 51.60~72.83 50.00~70.00 25 440 40 425 3.72 0.054 R/min 5.38±0.96 3.50~7.26 4.00~8.00 20 445 25 440 0.58 0.445 CI 0.70(0~1.70) -3.20~3.13 -3.00~3.00 21 444 30 435 1.68 0.195 EPL/% 0(0~0.60) 0~2.73 0~15.00 11 454 0 465 11.13 < 0.001 LY30/% 0(0~0.40) 0~2.47 0~7.50 11 454 0 465 11.13 < 0.001 G /(d/sc) 8 280.80 (7 108.00~9 709.00) 5 184.10~ 13 747.50 4 500.00~ 11 000.00 22 443 51 414 12.50 < 0.001 
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表 2 健康老年人不同年龄段间TEG各参数比较
类型 < 70岁(383例) ≥70岁(82例) P α角/° 64.18±6.44 64.29±6.63 0.894 K/min 1.80±0.54 1.80±0.61 0.935 MA/mm 62.20±5.26 62.38±6.10 0.786 R/min 5.37±0.98 5.39±0.88 0.847 CI 0.70 (-0.40~1.65) 0.60 (-0.50~1.78) 0.811 EPL/% 0(0~0.60) 0(0~0.50) 0.643 LY30/% 0(0~0.45) 0(0~0.40) 0.621 G/(d/sc) 8 198.60 (7 081.2~ 9 608.50) 8 764.95 (7 640.43~ 10 253.58) 0.032
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表 3 不同性别间TEG各参数比较
类型 男(227例) 女(238例) P α角/° 64.73±5.62 62.69±7.16 0.085 K/min 1.76±0.46 1.84±0.63 0.097 MA/mm 62.61±4.78 61.87±5.94 0.140 R/min 5.33±0.96 5.42±0.97 0.336 CI 0.80 (-0.30~1.60) 0.55 (-0.50~1.78) 0.355 EPL/% 0(0~0.60) 0(0~0.60) 0.557 LY30/% 0(0~0.30) 0(0~0.50) 0.195 G/(d/sc) 8 365.60 (7 318.35~ 9 729.60) 8 251.90 (6 994.83~ 9 573.63) 0.777
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表 4 老年人与年轻人TEG各参数比较
类型 老年人(465例) 年轻人(465例) P α角/° 64.20±6.47 62.27±7.76 < 0.001 K/min 1.80±0.56 1.98±0.72 < 0.001 MA/mm 62.23±5.41 65.56±8.81 < 0.001 R/min 5.38±0.96 5.29±1.28 0.248 CI 0.70 (-0.40~1.70) 0.30 (-1.00~1.60) 0.020 EPL/% 0(0~0.60) 0(0~1.00) 0.004 LY30/% 0(0~0.40) 0(0~0.80) 0.005 G/(d/sc) 8 280.80 (7 108.00~ 9 709.00) 8 247.80 (6 982.80~ 9 442.85) 0.229
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