血栓弹力图对老年重症患者深静脉血栓形成的预测价值

目的探讨血栓弹力图（thrombelastogram, TEG）对老年重症患者深静脉血栓（deep vein thrombosis, DVT）形成的预测价值。 方法选取2017年2月至2018年5月嘉兴市第一医院收治的59例老年重症患者作为研究对象，收集其入院1、3、5、7 d的静脉血，记录TEG和常规凝血试验（conventional coagulation test, CCT）的检测结果。采用t检验/秩和检验或χ²检验比较DVT组与非DVT组患者TEG和CCT各指标的差异。采用ROC曲线评价TEG与CCT各项指标对老年重症患者DVT的预测价值。 结果CCT检测结果显示，DVT组与非DVT组仅D-二聚体水平的差异有统计学意义（t=2.345，P<0.05）；TEG检测结果显示，DVT组凝集块形成速度、最大振幅、综合凝血指数均明显高于非DVT组，差异有统计学意义（t=2.151、2.614，F=13.750；P<0.05）；两组患者仅入院第5天的最大振幅差异有统计学意义（P<0.05）。ROC曲线分析结果可见临床预测DVT价值较好的指标依次为最大振幅、凝集块形成速度、综合凝血指数和D-二聚体，其敏感度分别为94.4%、50.0%、44.4%、95.1%，特异度分别为48.8%、85.4%、85.4%、33.3%，ROC曲线下面积分别为0.762、0.662、0.656、0.651。入ICU第5天最大振幅为67.5，是预测DVT发生的最佳临床诊断界值。 结论TEG预测老年重症患者DVT发生的准确性高于常规凝血试验指标。

Predictive value of thromboelasmogram for deep venous thrombosis in elderly patients with severe disease

ObjectiveTo the predictive value of TEG for formation of Deep vein thrombosis (DVT) in elderly patients with severe thrombelastogram. Methods59 elderly critically patients admitted to Jiaxing First Hospital from February 2017 to May 2018 were selected, venous blood samples were collected on the 1st, 3rd, 5th and 7th day after admission, and the results of TEG and CCT were recorded. TEG and CCT indexes were compared between DVT group and non DVT group by T-test/rank sum test or chi-square test. ROC curve was used to evaluate the predictive value of TEG and CCT for DVT in elderly patients with severe diseases. ResultsThe results of CCT showed that the difference of D-dimer (D-D) level between DVT group and non DVT group was statistically significant (t=2.345, P < 0.05); the results of TEG test showed that the formation speed, maximum amplitude and coagulation index of DVT group were significantly higher than those of non DVT group (t=2.151, 2.614; F=13.750; P < 0.05); and the maximum amplitude difference between the two groups was statistically significant only on the 5th day after admission (P < 0.05). According to the ROC curve analysis results, the indicators that are good at predicting the value of DVT clinically include maximum amplitude, agglutination velocity, coagulation index and D-D, the sensitivity is 94.4%, 50.0%, 44.4% and 95.1%, specificity is 48.8%, 85.4%, 85.4% and 33.3%, respectively, and area under the ROC curve is 0.762, 0.662, 0.656 and 0.651, respectively. Ma was 67.5 on the 5th day after admission into ICU, which was the best clinical diagnostic cut-off value for DVT. ConclusionThe accuracy of TEG in predicting DVT in elderly critically patients was higher than that of CCT.