2023 年第 1 期 第 18 卷

血栓弹力图在川崎病患儿冠状动脉病变及阿司匹林抗血小板疗效评估中的应用

Application of thrombelastography in evaluation of coronary artery lesions and antiplatelet efficacy of aspirin in children with Kawasaki disease

作者：陈敬师1张英谦1李博1郝京霞1王华1张会敏1石琳2刘力3

英文作者：Chen Jingshi1 Zhang Yingqian1 Li Bo1 Hao Jingxia1 Wang Hua1 Zhang Huimin1 Shi Lin2 Liu Li3

单位：1河北省儿童医院心内科河北省小儿心血管重点实验室，石家庄050000；2首都儿科研究所附属儿童医院心内科，北京100000；3天津市儿童医院风湿免疫科，天津300000

英文单位：1Department of Cardiology Children′s Hospital of Hebei Province Hebei Key Laboratory of Pediatric Cardiology Shijiazhuang 050000 China; 2Department of Cardiology Children′s Hospital Affiliated to Capital Institute of Pediatrics Beijing 100000 China; 3Department of Rheumatism and Immunology Tianjin Children′s Hospital Tianjin 300000 China

关键词：川崎病；血栓弹力图；冠状动脉病变；阿司匹林抵抗

英文关键词：Kawasakidisease;Thrombelastography;Coronaryarterylesions;Aspirinresistance

• 摘要：

• 目的  分析血栓弹力图(TEG)在川崎病患儿冠状动脉病变(CAL)及阿司匹林抗血小板疗效评估中的应用价值。方法 选取2017年8月1日至2021年8月31日于河北省儿童医院心内科就诊的98例川崎病患儿的临床资料进行回顾性分析。根据有无CAL将患儿分为CAL组和无CAL组，比较2组患儿临床资料及不同时期TEG指标，分析CAL的相关危险因素。通过TEG血小板图检测花生四烯酸（AA）途径血小板抑制率（AA%），将患儿分为阿司匹林敏感（AS，AA%≥50%）组和阿司匹林抵抗（AR，AA%＜50%）组，比较2组患儿临床及TEG指标，分析阿司匹林抗血小板疗效的影响因素。结果 98例患儿中CAL组29例，无CAL组69例。Logistic回归分析结果显示，白细胞计数（WBC）≥20×109/L、血小板压积（PCT）≥0.5%、活化部分凝血活酶时间（APTT）＞31 s是川崎病患儿发生CAL的独立危险因素。37例治疗前及口服小剂量阿司匹林后均行TEG检测的患儿中CAL组8例、无CAL组29例，组间比较结果显示，CAL组治疗前TEG指标中凝血反应时间(R值)、凝血形成时间(K值)均短于无CAL组(均P＜0.05)。CAL组和无CAL组患儿口服小剂量阿司匹林后TEG血小板图各指标比较，差异均无统计学意义（均P＞0.05）。川崎病患儿口服小剂量阿司匹林后检测AA%为60.4%（27.3%，86.8%）。其中AS组59例，AR组39例，AR发生率为39.8%（39/98）。AR组患儿口服小剂量阿司匹林后TEG指标中最大振幅确定后30 min血凝块幅度减少速率(LY30值)高于AS组（P=0.014）。结论 川崎病患儿治疗前TEG中R值、K值越低，越容易并发冠状动脉损伤，同时WBC、PCT增大、APTT延长者发生CAL的危险性升高。口服小剂量阿司匹林后TEG中LY30值升高与AR有关。TEG检测在川崎病CAL及阿司匹林抗血小板疗效评估方面有一定意义。

• Objective To analyze the value of thrombelastography (TEG) in evaluating coronary artery lesions (CAL) and antiplatelet efficacy of aspirin in children with Kawasaki disease. Methods The clinical data of 98 children with Kawasaki disease who visited Department of Cardiology, Children′s Hospital of Hebei Province from August 1, 2017 to August 31, 2021 were retrospectively analyzed. The children were divided into CAL group and non CAL group according to the presence or absence of CAL. The clinical data and TEG indexes in different periods were compared between the two groups, and the related risk factors of CAL were analyzed. The platelet inhibition rate (AA%) of arachidonic acid (AA) pathway was detected by TEG platelet graph. The children were divided into aspirin sensitive (AS, AA%≥50%) group and aspirin resistance (AR, AA%＜50%) group. The clinical and TEG indexes of the two groups were compared, and the influencing factors of aspirin antiplatelet efficacy were analyzed. Results Among 98 children, 29 were in the CAL group and 69 were in the non CAL group. Logistic regression analysis showed that white blood cell count (WBC) ≥20×109/L, plateletcrit (PCT) ≥0.5% and activated partial thromboplastin time (APTT)＞31 s were independent risk factors for CAL in children with Kawasaki disease. Among 37 children who underwent TEG detection before treatment and after taking low-dose aspirin orally, there were 8 cases in CAL group and 29 cases in non CAL group. The comparison results  between groups showed that the coagulation reaction time (R value) and coagulation formation time (K value) of TEG indicators in CAL group before treatment were shorter than those in non CAL group (both P＜0.05). There was no significant difference between CAL group and non CAL group in TEG platelet graph indices after taking low-dose aspirin orally (all P＞0.05). The AA% of children with Kawasaki disease after taking low-dose aspirin orally was 60.4%(27.3%, 86.8%). Among them, there were 59 cases in AS group and 39 cases in AR group. The incidence of AR was 39.8% (39/98). The percent fibrinolysis at 30 min post maximum amplitude (LY30) value of TEG after taking low-dose aspirin orally in AR group was higher than that in AS group (P=0.014). Conclusions The lower R value and K value in TEG before treatment, the more prone to coronary artery injure. At the same time, those with increased WBC, PCT and prolonged APTT have an increased risk of CAL. The increase of LY30 value in TEG after oral administration of low-dose aspirin is related to AR. TEG detection has certain significance in evaluating the CAL and antiplatelet efficacy of aspirin in Kawasaki disease.