摘要【目的】探讨血栓弹力图(TEG)和常规凝血功能指标对危重新生儿凝血功能异常的诊断效能及其意义。【方法】回顾性分析2016年8月至2019年4月河南省人民医院收治的160例危重新生儿临床资料。依据常规凝血功能检查结果将其分为凝血功能异常组(观察组, n =90)和凝血功能正常组 (对照组, n =70),两组均行TEG检查。比较两组常规凝血功能检查结果、TEG参数,分析观察组中不同病情患儿TEG参数变化,采用Pearson法分析各指标相关性,并绘制受试者工作特征曲线(ROC)评估各指标对危重新生儿的诊断价值。【结果】观察组PT、APTT、TT较正常组明显延长( P <0.05),TEG中R值、K值较对照组明显缩短,而α角、EPL、LY30均高于对照组( P <0.05),两组FIB、MA比较差异无统计学意义( P >0.05)。极危重患儿PT、APTT较危重患儿明显延长( P <0.05),R值、K值短于危重患儿,而LY30高于危重患儿( P <0.05)。Pearson相关分析表明,R值与PT、APTT呈负相关,而与TT无相关性,K值与APTT呈负相关( P <0.05),EPL、LY30与PT、APTT均有较好相关性( P <0.05)。ROC曲线显示,常规凝血指标中APTT的曲线下面积最高,TEG参数中R值、LY30的曲线下面积较高,除K值外,TEG其他参数的曲线下面积均高于常规凝血功能指标,TEG的整体诊断效能高于常规凝血功能检查。【结论】与常规凝血功能检查相比,TEG用于诊断危重新生儿凝血功能异常的价值更高,且TEG各参数有着密切关系,可将其作为辅助检查手段。
Abstract：【Objective】To investigate the diagnostic efficacy and significance of thromboelastography (TEG) and routine coagulation function indexes in the diagnosis of coagulation dysfunction in critically ill neonates. 【Methods】The clinical data of 160 cases of critical rebirth in Henan Provincial People's Hospital from August 2016 to April 2019 were retrospectively analyzed. According to the results of routine coagulation function examination, the patients were divided into abnormal coagulation function group (observation group, n =90) and normal coagulation function group (control group, n =70).TEG was performed in both groups.The results of routine coagulation function examination and TEG parameters were compared between the two groups. The changes of TEG parameters of children with different conditions in the observation group were analyzed. Pearson method was used to analyze the correlation of each index, and receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic value of each index for critically ill newborns.【Results】PT, APTT and TT in the observation group were significantly longer than those in the normal group ( P <0.05), R value and K value in TEG were significantly shorter than those in the control group; α angle, EPL and LY30 in the observation group were higher than those in the control group ( P <0.05), and there was no significant difference in FIB and MA between the two groups ( P >0.05). The PT and APTT of most critically ill children were significantly longer than those of critically ill children ( P <0.05), the R and K values were shorter than those of critically ill children, and the LY30 value was higher than that of critically ill children ( P <0.05).Pearson correlation analysis showed that R value was negatively correlated with PT and APTT, but not with TT. K value was negatively correlated with APTT ( P <0.05). EPL and LY30 were well correlated with PT and APTT ( P <0.05). ROC curve showed that APTT had the highest area under the curve in conventional coagulation indexes, and R value and LY30 had higher area under the curve in TEG parameters. Except K value, the area under the curve of other TEG parameters were higher than that of conventional coagulation function indexes. The overall diagnostic efficiency of TEG was higher than that of conventional coagulation function examination.【Conclusion】Compared with routine coagulation function test, TEG has higher value in the diagnosis of coagulation dysfunction in critically ill neonates, and the parameters of TEG are closely related, so it can be used as an auxiliary examination method.
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2021, Vol. 38 
