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赵文学.血清同型半胱氨酸和血小板参数联合血栓弹力图可评估急性创伤伴凝血功能障碍患者的预后[J].内科急危重症杂志,2025,31(5):445-448
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| DOI：10.11768/nkjwzzzz20250510 |
| 中文关键词: 急性创伤 凝血功能障碍 血清同型半胱氨酸 血小板参数 血栓弹力图 |
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| 摘要点击次数: 17 |
| 全文下载次数: 19 |
| 中文摘要: |
| 摘要 目的：探究血清同型半胱氨酸（Hcy）和血小板参数联合血栓弹力图（TEG）评估急性创伤伴凝血功能障碍患者预后的临床价值。方法：回顾性分析104例急性创伤伴凝血功能障碍患者的临床资料。根据损伤严重程度评分（ISS）将患者分为非危重组（49例）、危重组（33例）和极危重组（22例）。对比不同危重程度患者的血清Hcy水平、血小板参数 [血小板计数（PLT）、平均体积（MPV）、体积分布宽度（PDW）]、TEG [凝血反应时间（R）、血块形成速率（K）、弹力图最大切角（Angle）、血块最大强度（MA）]。根据患者4周内的临床结局分为存活组（73例）和死亡组（31例）。采用Logistic回归分析影响患者预后的危险因素，采用受试者工作特征（ROC）曲线分析血清Hcy和血小板参数联合TEG对患者预后的预测价值。结果：极危重组的PLT、Angle、MA值均低于危重组，危重组低于非危重组(P均＜0.05)；极危重组血清Hcy水平、MPV、PDW、R、K值均高于危重组，危重组高于非危重组（P均＜0.05）。死亡组血清Hcy水平、R、K值高于存活组，PLT、Angle、MA水平低于存活组（P均＜0.05）。Logistic回归分析显示血清Hcy、R、K、PLT、Angle、MA是影响患者预后的独立危险因素（P均＜0.05）。经ROC曲线分析，结果显示血清Hcy、PLT、R、K、Angle、MA各自单独及联合检测对预后预测的曲线下面积分别为0.777、0.797、0.757、0.791、0.791、0.680、0.887，敏感度分别为74.19%、83.87%、70.97%、70.97%、70.97%、64.52%、90.32%，特异性分别为68.49%、72.60%、79.45%、78.08%、68.49%、68.49%、79.45%（P均＜0.05）。结论：血清Hcy、血小板参数、TEG在不同危重程度和不同预后的急性创伤伴凝血功能障碍患者中存在显著差异，且对患者的预后有预测价值。 |
| 英文摘要: |
| Abstract Objective: To explore the clinical value of serum homocysteine (Hcy), platelet parameters combined with thromboelastogram (TEG) in evaluating the prognosis of patients with acute trauma complicated with coagulation dysfunction. Methods: The clinical data of 104 patients with acute trauma complicated with coagulation dysfunction were retrospectively analyzed. According to the injury severity score (ISS), the patients were divided into a non-critical group (49 cases), a critical group (33 cases), and an extremely critical group (22 cases). The serum Hcy levels, platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW)], and TEG parameters [coagulation reaction time (R), clot formation rate (K), maximum angle of the elastogram (Angle), maximum clot strength (MA)] were compared among patients with different severities. Based on the clinical outcomes within 4 weeks, the patients were divided into a survival group (73 cases) and a death group (31 cases). Logistic regression analysis was used to identify the risk factors affecting the patients' prognosis, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum Hcy, platelet parameters combined with TEG for the patients' prognosis. Results: The values of PLT, Angle, and MA in the extremely critical group were lower than those in the critical group, and those in the critical group were lower than those in the non-critical group(all P< 0.05). The serum Hcy levels, MPV, PDW, R, and K values in the extremely critical group were higher than those in the critical group, and those in the critical group were higher than those in the non-critical group (all P< 0.05). The serum Hcy levels, R, and K values in the death group were higher than those in the survival group, while the PLT, Angle, and MA levels were lower than those in the survival group (all P< 0.05). Logistic regression analysis showed that serum Hcy, R, K, PLT, Angle, and MA were independent risk factors affecting the patients' prognosis (all P< 0.05). ROC curve analysis revealed that the areas under the curve (AUC) for the prediction of prognosis by serum Hcy, PLT, R, K, Angle, MA alone and in combination was 0.777, 0.797, 0.757, 0.791, 0.791, 0.680, and 0.887, respectively. The sensitivities were 74.19%, 83.87%, 70.97%, 70.97%, 70.97%, 64.52%, and 90.32%, respectively, and the specificities were 68.49%, 72.60%, 79.45%, 78.08%, 68.49%, 68.49%, and 79.45%, respectively (all P< 0.05). Conclusion: There are significant differences in serum Hcy, platelet parameters, and TEG among patients with acute trauma complicated with coagulation dysfunction of different severities and different prognoses, and they have predictive value for the patients' prognosis. |
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