2018 年第 10 期 第 13 卷

血栓弹力图在急性心肌梗死合并慢性肾脏病患者凝血功能评价中的作用

Application of thrombelastography in evaluation of coagulation function in patients with acute myocardial infarction complicated with chronic kidney disease

作者：魏明张素娟宋毓青吴其明

英文作者：

单位：100015首都医科大学附属北京地坛医院心内科

英文单位：

关键词：急性心肌梗死；血栓弹力图；慢性肾脏病

英文关键词：

• 摘要：

• 【摘要】目的    探讨血栓弹力图（TEG）在急性心肌梗死（AMI）合并慢性肾脏病（CKD）患者凝血功能评价中的作用。方法    连续选取2015年1月至2017年10月在首都医科大学附属北京地坛医院心内科监护病房住院治疗的AMI合并CKD患者52例作为观察组，随机选取同期在该病房住院治疗的肾功能正常的AMI患者52例作为对照组。比较2组患者TEG指标［包括反应时间（R值）、血栓最大弹力度（MA值）、花生四烯酸（AA）抑制率、二磷酸腺苷（ADP）抑制率、AA的MA值、ADP的MA值、血凝块动力（K值）、血凝块形成的速率（Angle值）］、常规凝血指标［包括凝血活酶时间、活化部分凝血活酶时间、纤维蛋白原（FIB)］以及常规临床检验指标（血红蛋白、肾小球滤过率、C反应蛋白、血尿酸、血脂谱等）。分析TEG各指标与临床相关指标的相关关系。结果    2组凝血活酶时间、活化部分凝血活酶时间差异无统计学意义(均 P＞0.05)。观察组的血红蛋白水平低于对照组，FIB水平高于对照组［（127±22）g/L比（137±14）g/L、（3.9±1.3）g/L比（3.1±1.3）g/L］，差异均有统计学意义（均P<0.05）。观察组MA值大于、K值小于对照组，差异有统计学意义（P＜0.05）。MA值与FIB水平呈正相关（r=0.236，P=0.036），与R值呈负相关（r=-0.511，P<0.001），与Angle值呈正相关（r=0.218，P=0.032）；肾小球滤过率与冠状动脉病变支数呈负相关（r=-0.266，P=0.009）, 与FIB水平呈负相关（r=-0.247，P=0.026）。单因素回归分析结果显示，GFR是ADP抑制率的独立影响因素（β=0.38，P=0.031）。结论    TEG可以反映出AMI合并CKD较肾功能正常的AMI患者血液呈高凝状态，为临床医师制定个体化的抗栓治疗平衡出血风险提供参考。

• 【Abstract】Objective    To investigate the value of thrombelastography （TEG） in evaluation of coagulation function in patients with acute myocardial infarction(AMI) complicated with chronic kidney disease(CKD). Methods    From January 2015 to October 2017, 52 patients with AMI complicated with CKD were enrolled in Beijing Ditan Hospital, Capital Medical University as observation group; 52 patients with normal renal function were enrolled as control group. TEG parameters［including reaction time(R), maximum amplitude(MA), arachidonic acid(AA) inhibition rate, adenosine diphosphate(ADP) inhabitation rate, AA-MA, ADP-MA, coagulation time(K), coagulation rate (Angle)］, routine coagulation indicators［including thromboplastin time(TT), activated partial thromboplastin time(APTT), fibrinogen(FIB)］ and common clinical indicators［including hemoglobin, glomerular filtration rate(GFR), C-reactive protein, uric acid, blood lipid spectrum］ were analyzed. Results    There was no significant difference of TT and APTT between the two groups(P>0.05). Hemoglobin in the observation group was lower and FIB was higher than those in the control group［（127±22）g/L vs （137±14）g/L, （3.9±1.3）g/L vs （3.1±1.3）g/L］（P<0.05）. MA value in the observation group was higher and K value was lower than those in the control group(P<0.05). MA was positively correlated with FIB(r=0.236, P=0.036); it was negatively correlated with the R value(r=-0.511, P<0.001); it was positively correlated with Angle(r=0.218, P=0.032). GFR was negatively correlated with the number of coronary artery lesions(r=-0.266, P=0.009); it was negatively correlated with FIB（r=-0.247, P=0.026）. Single factor regression analysis showed that GFR was an independent influence factor of ADP inhibition rate(β=0.38, P=0.031). Conclusion    TEG shows the hypercoagulable state of blood in AMI patients with CKD, suggesting the importance of anti-thrombus therapy to reduce bleeding risk.