Predictive value of platelet and thromboelastography in bleeding risk and platelet transfusion in patients with hematological diseases
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摘要: 目的 探索血小板计数(platelet count，PLT)及血栓弹力图(thromboelastography，TEG)在预测血液病患者出血风险和指导血小板输注中的作用。方法 收集2019年1月—2019年10月医院血液科收治的PLT减少(< 50×109/L)的患者398例。根据TEG中凝血最大强度(MA)值50 mm为临界值，分为MA < 50 mm 255例(A组)和MA≥50 mm 143例(B组)。分析2组间的基本情况，PLT、出血概率及前7天预防性血小板输注情况；对影响出血的单因素及多因素进行分析；比较PLT、MA及PLT联合MA在预测血液病患者出血的灵敏度及特异度。结果 2组间的性别、年龄、BMI、体表面积及TEG中的凝血反应时间差异无统计学意义(P>0.05)，在PLT、TEG中的凝血形成时间、凝血形成速率、凝血综合指数上差异有统计学意义(P < 0.05)。2组患者在前1天、前3天、前7天PLT输注率差异有统计学意义(P < 0.05)，2组患者在前2、4、5、6天PLT输注率差异无统计学意义(P>0.05)。PLT(P < 0.05，OR=0.962，95%CI 0.932~0.992)是出血的独立保护因素，MA(P < 0.05，OR=0.947，95%CI 0.921~0.973)是出血的独立保护因素。PLT和MA值联合诊断曲线下面积(AUC)为0.736，灵敏度为67.69%，特异度为70.87%。结论 PLT联合MA值预测血液病患者出血的灵敏度、特异度相对较高，在降低血液病患者出血风险、明确血小板预防性输注时机、减少血小板资源浪费、节省医疗支出中具有重要价值。Abstract: Objective To explore the role of platelet count(PLT) and thromboelastography(TEG) in predicting bleeding risk and guiding platelet transfusion in patients with hematological diseases.Methods A total of 398 patients with thrombocytopenia(< 50×109/L) admitted to the Department of Hematology of the hospital from January 2019 to October 2019 were collected. According to the maximum coagulation intensity(MA) value of 50 mm in TEG as the critical value, they were divided into 255 cases with MA < 50 mm(group A) and 143 cases with MA≥50 mm(group B). The basic situation, PLT, bleeding probability and prophylactic platelet transfusion in the first 7 days were analyzed between the two groups. The univariate and multivariate factors affecting bleeding were analyzed. The sensitivity and specificity of PLT, MA and PLT combined with MA in predicting bleeding in patients with hematological diseases were compared.Results There was no significant difference in gender, age, height, weight, body surface area and TEG coagulation reaction time between the two groups(P>0.05), but there were significant differences in PLT, TEG coagulation formation time, coagulation formation rate and coagulation index(P < 0.05). There was a significant difference in the first 1 d, 3 d and 7 d PLT transfusion rate between the two groups(P < 0.05), but there was no significant difference in the first 2, 4, 5, 6 d PLT transfusion rate between the two groups(P>0.05). PLT(P < 0.05, OR=0.962, 95%CI 0.932-0.992) was an independent protective factor for bleeding, MA(P < 0.05, OR=0.947, 95%CI 0.921-0.973) was an independent protective factor for bleeding. The area under the curve(AUC) of PLT and MA value combined diagnosis was 0.736, the sensitivity was 67.69%, and the specificity was 70.87%.Conclusion The sensitivity and specificity of PLT combined with MA value in predicting bleeding in patients with hematological diseases were relatively high, which might have important value in reducing the risk of bleeding in patients with hematological diseases, determining the timing of platelet prophylactic infusion, reducing the waste of platelet resources and saving medical expenditure.
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Key words:
- thromboelastography /
- platelet function /
- prophylactic transfusion /
- thrombocytopenia /
- bleeding
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表 1 2组患者基础资料比较
项目 A组(n=255) B组(n=143) χ2/Z P 性别/例(%) 0.928 0.335 男 204(80.00) 120(83.92) 女 51(20.00) 23(16.08) 年龄/岁 29.00(24.00，42.00) 30.00(24.00，42.00) -1.586 0.113 BMI 21.80(19.03，23.44) 22.47(19.22，24.34) -1.874 0.061 体表面积/m2 1.64(1.51，1.72) 1.61(1.53，1.74) -1.071 0.284 PLT/(×109/L) 18.00(12.00，26.00) 27.00(21.00，36.00) -7.559 < 0.001 R/min 8.00(6.40，9.30) 8.60(6.80，9.70) -1.897 0.058 K/min 2.80(2.30，3.20) 2.20(1.90，2.80) -6.475 < 0.001 Angle/° 53.50(48.20，59.00) 59.40(55.30，64.00) -6.956 < 0.001 CI -7.50(-10.10，-5.60) -3.90(-5.70，-2.50) -9.874 < 0.001 
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表 2 2组患者出血率及前7天输注血小板情况比较
例(%) 组别 出血 前7天输注PLT情况 前1天 前2天 前3天 前4天 前5天 前6天 前7天 未输血 A组(n=255) 58(22.75) 40(15.78) 37(14.51) 31(12.16) 38(14.90) 31(12.16) 33(12.94) 20(7.84) 132(51.76) B组(n=143) 7(4.90) 40(27.97) 24(16.78) 33(23.08) 24(16.78) 26(18.18) 25(17.48) 22(15.38) 99(69.23) χ2 21.364 8.611 0.365 8.096 0.247 2.710 1.518 5.520 11.477 P < 0.001 0.003 0.546 0.004 0.620 0.100 0.218 0.019 0.001
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表 3 影响出血单因素分析
项目 未出血(n=333) 出血(n=65) χ2/Z P 性别/例(%) 1.862 0.172 男 275(82.58) 49(75.38) 女 58(17.42) 16(24.62) 年龄/岁 29.00(24.00，40.00) 30.00(22.00，49.00) -0.431 0.667 BMI 21.97(19.03，23.38) 22.04(19.05，24.14) -0.974 0.330 体表面积/m2 1.64(1.51，1.73) 1.62(1.58，1.69) -0.060 0.952 PLT/(×109/L) 22.00(16.00，32.00) 14.00(8.00，22.50) -4.892 < 0.001 R/min 8.30(6.50，9.60) 8.00(6.90，9.40) -0.091 0.928 K/min 2.60(2.10，3.00) 2.60(1.90，3.05) -0.716 0.474 Angle/° 56.50(50.55，61.60) 52.40(47.80，59.20) -2.627 0.009 MA 47.40(35.40，54.40) 32.40(24.60，45.10) -5.584 < 0.001 CI -6.10(-8.55，-3.70) -7.50(-10.35，-5.10) -2.602 0.009
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表 4 影响出血多因素分析结果
指标 β SE Wald χ2 P OR 95%CI PLT -0.039 0.016 5.976 0.014 0.962 0.932~0.992 Angle -0.011 0.018 0.373 0.542 0.989 0.954~1.025 MA -0.054 0.014 15.113 < 0.001 0.947 0.921~0.973 CI 0.026 0.038 0.488 0.485 1.027 0.953~1.106
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表 5 PLT、MA及联合诊断出血的结果
指标 AUC SE P 95%CI 最佳截断值 灵敏度/% 特异度/% PLT 0.692 0.038 < 0.001 0.617~0.766 14.50×109/L 52.31 78.98 MA 0.719 0.035 < 0.001 0.650~0.788 47.35 mm 84.62 50.45 PLT+MA 0.736 0.035 < 0.001 0.668~0.805 - 67.69 70.87
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[1] 马翠霞, 燕备战, 史景莉. 血栓弹力图联合血小板抗体检测在孕期合并血小板减少中的应用研究[J]. 中国生育健康杂志, 2022, 33(5): 455-458. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK202205010.htm
[2] Chen LZ, Zheng YQ, Yu K, et al. Changing causes of death in persons with haematological cancers 1975-2016[J]. Leukemia, 2022, 36(7): 1850-1860. doi: 10.1038/s41375-022-01596-z
[3] Ellingson KD, Sapiano MRP, Haass KA, et al. Continued decline in blood collection and transfusion in the United States-2015[J]. Transfusion, 2017, 57(Suppl 2): 1588-1598.
[4] 游时松, 卢黎琦, 蔡群, 等. 310名血液病患者单采血小板输注效果分析[J]. 中国输血杂志, 2023, 36(1): 36-41. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202301009.htm
[5] 叶子君, 方拥军, 戴宇东, 等. 初治儿童急性淋巴细胞白血病出血风险分析[J]. 临床血液学杂志, 2019, 32(11): 874-876, 881. doi: 10.13201/j.issn.1004-2806.2019.11.012
[6] 温丽玲, 余卓丽, 梁惠兰, 等. 英国血小板输注应用指南主要推荐及其启示[J]. 中国输血杂志, 2018, 31(4): 440-444. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201805050.htm
[7] Cornelissen LL, Caram-Deelder C, Fustolo-Gunnink SF, et al. Expected individual benefit of prophylactic platelet transfusions in hemato-oncology patients based on bleeding risks[J]. Transfusion, 2021, 61(9): 2578-2587. doi: 10.1111/trf.16587
[8] 许云波, 张静. 血液病反复输血患者血小板抗体、交叉配型结果与血小板输注效果的相关性分析[J]. 国际检验医学杂志, 2020, 41(3): 323-326. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202003017.htm
[9] 敬媛媛, 王洁, 刘娜, 等. 免疫性血小板输注无效患者的人类白细胞抗原/人类血小板抗原抗体分布特征及其对交叉配型效果的影响[J]. 北京医学, 2022, 44(2): 163-167. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202202015.htm
[10] Chellaiya GK, Nair CK, Raghavan V, et al. Extent of transfusion support in a developing country in managing a bleeding acute myeloid leukemia patient with platelet transfusion refractoriness[J]. Asian J Transfus Sci, 2021, 15(1): 90-93.
[11] 胡燕, 严顺东, 吴雅娟, 等. 低剂量血小板预防性输注分析[J]. 临床血液学杂志, 2022, 35(10): 720-723. doi: 10.13201/j.issn.1004-2806.2022.10.006
[12] Jaime-Pérez JC, García-Salas G, Turrubiates-Hernández GA, et al. An audit of platelet transfusion indications in acute leukaemia patients: six-year experience at an Academic Centre[J]. Trasfusione Del Sangue, 2021, 19(1): 37-44.
[13] Snowden JA, Sánchez-Ortega I, Corbacioglu S, et al. Indications for haematopoietic cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2022[J]. Bone Marrow Transplant, 2022, 57(8): 1217-1239.
[14] 杨俊龙, 彭涛, 张利, 等. 新生儿与成年人血栓弹力图结果比较分析[J]. 西南军医, 2020, 22(4): 325-327. https://www.cnki.com.cn/Article/CJFDTOTAL-JYXN202004008.htm
[15] 张涛, 万亚楠, 卢昕媛, 等. 血栓弹力图对脓毒症患者弥散性血管内凝血的诊断价值及预后的影响[J]. 临床急诊杂志, 2022, 23(7): 476-481. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202207004.htm
[16] 朱雯雯, 李莺, 周小玉. 血栓弹力图评估心脑血管疾病抗血小板药物使用疗效的影响因素[J]. 临床血液学杂志, 2023, 36(4): 225-230. doi: 10.13201/j.issn.1004-2806.2023.04.001
[17] He YL, Yao HJ, Ageno W, et al. Review article: thromboelastography in liver diseases[J]. Aliment Pharmacol Ther, 2022, 56(4): 580-591.
[18] 李娜, 袁君, 栾建凤. 血栓弹力图相较常规凝血检测在热射病救治中的比较研究[J]. 临床血液学杂志, 2023, 36(12): 869-872. doi: 10.13201/j.issn.1004-2806.2023.12.006
[19] 黎欢, 杨俊龙, 谢佳, 等. 肝硬化患者血栓弹力图与凝血指标的相关性分析[J]. 现代医药卫生, 2022, 38(7): 1089-1093. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202207003.htm
[20] Cornelissen LL, Caram-Deelder C, Meier RT, et al. Platelet transfusion and tranexamic acid to prevent bleeding in outpatients with a hematological disease: a Dutch nationwide survey[J]. Eur J Haematol, 2021, 106(3): 362-370.
[21] 侯星羽, 秦雯, 海帆, 等. 肝移植患者围术期PBM的建立与实施[J]. 中国输血杂志, 2023, 36(11): 999-1004. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202311006.htm
[22] Facco G, Bennardello F, Fiorin F, et al. A nationwide survey of clinical use of blood in Italy[J]. Blood Transfus, 2021, 19(5): 384-395.
[23] 何柏霖, 郭玉霞, 温普生, 等. 儿童急性淋巴细胞白血病血小板输注影响因素及疗效预测模型的构建与验证[J]. 中国循证儿科杂志, 2023, 18(6): 435-441. https://www.cnki.com.cn/Article/CJFDTOTAL-XZEK202306005.htm
[24] 陈瑜, 温燕华, 邱芳, 等. 血栓弹力图在冠状动脉旁路移植术个体化成分输血的应用价值分析[J]. 临床血液学杂志, 2023, 36(10): 751-754. doi: 10.13201/j.issn.1004-2806.2023.10.013
[25] Tan LC, Wei XZ, Yue JM, et al. Impact of perioperative massive transfusion on long term outcomes of liver transplantation: a retrospective cohort study[J]. Int J Med Sci, 2021, 18(16): 3780-3787.
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