食管癌凝血紊乱多模态预警模型: 基于血栓弹力图与常规凝血指标联合动态监测的预后评估体系

Multimodal warning model for coagulopathy in esophageal cancer: a prognostic dynamic assessment system integrating thromboelastography and conventional coagulation parameters

  • 摘要:
    目的 探究血栓弹力图(TEG)联合常规凝血指标对食管癌患者凝血功能的评估价值及其与预后的关系。
    方法 选取本院2018年8月—2020年8月收治的100例食管癌患者为研究对象, 根据患者有无静脉血栓分为研究组(高凝)和对照组(非高凝),根据患者预后情况分为预后良好组(生存, n=66)和预后不良组(死亡, n=34)。采用TEG仪检测TEG指标血凝块形成时间(K)、凝血反应时间(R)、最大振幅(MA)、凝血指数(CI)以及凝血形成速率(Angle角); 采用全自动凝血分析仪检测常规凝血指标凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)水平; 采用Pearson相关性分析探讨TEG指标与常规凝血指标的相关性; 采用Logistic回归分析探讨食管癌患者凝血功能的影响因素; 绘制受试者工作特征(ROC)曲线,分析TEG联合常规凝血指标对食管癌患者凝血功能的评估价值。
    结果 研究组K和R短于对照组, MA、CI和Angle角大于对照组,差异有统计学意义(P < 0.05)。研究组PT、APTT、TT短于对照组, FIB高于对照组,差异有统计学意义(P < 0.05)。根据Pearson相关性分析可知, PT、APTT、TT与K、R呈正相关,与MA、CI和Angle角呈负相关(P < 0.05); FIB与K、R呈负相关,与MA、CI和Angle角呈正相关(P < 0.05)。多因素Logistic回归分析显示, MA较大、CI高、Angle角较大、FIB水平高为食管癌患者凝血功能的危险因素, PT长、APTT长、TT长、K长、R长为保护因素(P < 0.05)。ROC曲线显示, K、R、MA、CI、Angle角、PT、APTT、TT、FIB联合评估食管癌患者凝血功能的曲线下面积(AUC)为0.987, 优于各个指标单独评估(P < 0.05)。预后不良组K、R、PT、APTT、TT短于预后良好组, MA、CI、Angle角、FIB大于或高于预后良好组,差异有统计学意义(P < 0.05)。
    结论 TEG联合常规凝血指标建立的参数联合模型可提高对食管癌患者凝血功能与预后的评估价值。

     

    Abstract:
    Objective To explore the value of thromboelastography (TEG) combined with conventional coagulation indicators in evaluating the coagulation function of patients with esophageal cancer and its relationship with prognosis.
    Methods A total of 100 patients with esophageal cancer admitted to our hospital from August 2018 to August 2020 were selected as the study subjects. They were divided into study group (hypercoagulable state) and control group (non-hypercoagulable state) according to the presence or absence of venous thrombosis, and further divided into good prognosis group (survival, n=66)and poor prognosis group (death, n=34) according to their prognosis. TEG indicators clot formation time (K), reaction time (R), maximum amplitude (MA), coagulation index (CI), and clot formation rate (Angle) were detected using a TEG instrument; conventional coagulation indicators prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) were detected using an automatic coagulation analyser; Pearson correlation analysis was used to explore the correlation between TEG indicators and conventional coagulation indicators; logistic regression analysis was used to explore the influencing factors of coagulation function in patients with oesophageal cancer; receiver operating characteristic (ROC) curves were drawn to analyse the value of TEG combined with conventional coagulation indicators in evaluating the coagulation function of patients with esophageal cancer.
    Results The K and R values in the study group were shorter than those in the control group, while the MA, CI, and Angle values were larger, with statistically significant differences (P < 0.05). The PT, APTT, and TT values in the study group were shorter than those in the control group, and the FIB level was higher, with statistically significant differences (P < 0.05). According to Pearson correlation analysis, PT, APTT, and TT were positively correlated with K and R, and negatively correlated with MA, CI, and Angle (P < 0.05); FIB was negatively correlated with K, and R and positively correlated with MA, CI, and Angle (P < 0.05). Multivariate logistic regression analysis showed that larger MA, high CI, larger Angle, and high FIB level were risk factors for the coagulation function of patients with esophageal cancer, while longer PT, APTT, TT, K, and R were protective factors (P < 0.05). The ROC curve showed that the area under the curve (AUC) for the combined evaluation of the coagulation function of patients with oesophageal cancer using K, R, MA, CI, Angle, PT, APTT, TT, and FIB was 0.987, which was superior to the evaluation by each indicator alone (P < 0.05). The K, R, PT, APTT, and TT values in the poor prognosis group were shorter than those in the good prognosis group, while the MA, CI, Angle, and FIB levels were larger or higher, with statistically significant differences (P < 0.05).
    Conclusion The parameter combination model established by combining TEG with conventional coagulation indicators can improve the evaluation value of the coagulation function and prognosis of patients with oesophageal cancer.

     

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