目的:探索血小板计数(platelet count,PLT)及血栓弹力图(thromboelastography,TEG)在预测血液病患者出血风险和指导血小板输注中的作用.方法:收集2019年1月—2019年10月医院血液科收治的PLT减少(＜50× 109/L)的患者398例.根据TEG中凝血最大强度(MA)值50 mm为临界值,分为MA＜50 mm 255例(A组)和MA≥50 mm 143例(B组).分析2组间的基本情况,PLT、出血概率及前7天预防性血小板输注情况;对影响出血的单因素及多因素进行分析;比较PLT、MA及PLT联合MA在预测血液病患者出血的灵敏度及特异度.结果:2组间的性别、年龄、BMI、体表面积及TEG中的凝血反应时间差异无统计学意义(P＞0.05),在PLT、TEG中的凝血形成时间、凝血形成速率、凝血综合指数上差异有统计学意义(P＜0.05).2组患者在前1天、前3天、前7天PLT输注率差异有统计学意义(P＜0.05),2组患者在前2、4、5、6天PLT输注率差异无统计学意义(P＞0.05).PLT(P＜0.05,OR=0.962,95％CI 0.932～0.992)是出血的独立保护因素,MA(P＜0.05,OR=0.947,95％CI 0.921～0.973)是出血的独立保护因素.PLT和MA值联合诊断曲线下面积(AUC)为0.736,灵敏度为67.69％,特异度为70.87％.结论:PLT联合MA值预测血液病患者出血的灵敏度、特异度相对较高,在降低血液病患者出血风险、明确血小板预防性输注时机、减少血小板资源浪费、节省医疗支出中具有重要价值.
Predictive value of platelet and thromboelastography in bleeding risk and platelet transfusion in patients with hematological diseases
Objective:To explore the role of platelet count(PLT)and thromboelastography(TEG)in predic-ting bleeding risk and guiding platelet transfusion in patients with hematological diseases.Methods:A total of 398 patients with thrombocytopenia(＜50 ×109/L)admitted to the Department of Hematology of the hospital from January 2019 to October 2019 were collected.According to the maximum coagulation intensity(MA)value of 50 mm in TEG as the critical value,they were divided into 255 cases with MA＜50 mm(group A)and 143 cases with MA≥50 mm(group B).The basic situation,PLT,bleeding probability and prophylactic platelet transfusion in the first 7 days were analyzed between the two groups.The univariate and multivariate factors affecting bleeding were analyzed.The sensitivity and specificity of PLT,MA and PLT combined with MA in predicting bleeding in patients with hematological diseases were compared.Results:There was no significant difference in gender,age,height,weight,body surface area and TEG coagulation reaction time between the two groups(P＞0.05),but there were significant differences in PLT,TEG coagulation formation time,coagulation formation rate and coagu-lation index(P＜0.05).There was a significant difference in the first 1 d,3 d and 7 d PLT transfusion rate be-tween the two groups(P＜0.05),but there was no significant difference in the first 2,4,5,6 d PLT transfusion rate between the two groups(P＞0.05).PLT(P＜0.05,OR=0.962,95％CI 0.932-0.992)was an independent protective factor for bleeding,MA(P＜0.05,OR=0.947,95％CI 0.921-0.973)was an independent protective factor for bleeding.The area under the curve(AUC)of PLT and MA value combined diagnosis was 0.736,the sensitivity was 67.69％,and the specificity was 70.87％.Conclusion:The sensitivity and specificity of PLT com-bined with MA value in predicting bleeding in patients with hematological diseases were relatively high,which might have important value in reducing the risk of bleeding in patients with hematological diseases,determining the timing of platelet prophylactic infusion,reducing the waste of platelet resources and saving medical expendi-ture.
NETL
NSTL
万方数据
