CAJ | 학술논문

目的评价血栓弹力图（ TEG ）在诊断营养不良血液透析患者凝血功能障碍中的作用。方法选择30例维持性血液透析（ MHD）患者和20例正常人，检测血红蛋白、血小板数量、凝血功能、白蛋白、前白蛋白、血脂和TEG。以主观综合性营养评估将患者分为营养不良组和营养正常组，比较三组以上指标的差异。结果（1） MHD患者血红蛋白、血小板、高密度脂蛋白较对照组降低。营养不良的发生率为46.6％，营养不良患者白蛋白、前白蛋白、总胆固醇低于营养正常者（P＜0.05）。（2）营养正常组患者常规凝血功能检查与对照组相比无显著性差异（ P＞0.05）。营养不良组与对照组比较，凝血酶原时间、国际标准化比值延长，纤维蛋白原升高（ P＜0.05）；与营养正常组比较，常规凝血功能检查无显著性差异（P＞0.05）。（3）与对照组相比，MHD患者TEG反应时间（R值）延长，凝血指数（CI）负值增大，营养不良患者最大振幅（MA值）增大（P＜0.05）。营养不良组与营养正常组比较，MA值增大，CI负值增大（ P＜0.05）。结论 MHD患者常存在营养不良，凝血功能改变较为复杂，常规凝血功能结合TEG检查能够早期发现不同营养状况血透患者凝血功能的异常。
목적평개혈전탄력도（ TEG ）재진단영양불량혈액투석환자응혈공능장애중적작용。방법선택30례유지성혈액투석（ MHD）환자화20례정상인，검측혈홍단백、혈소판수량、응혈공능、백단백、전백단백、혈지화TEG。이주관종합성영양평고장환자분위영양불량조화영양정상조，비교삼조이상지표적차이。결과（1） MHD환자혈홍단백、혈소판、고밀도지단백교대조조강저。영양불량적발생솔위46.6％，영양불량환자백단백、전백단백、총담고순저우영양정상자（P＜0.05）。（2）영양정상조환자상규응혈공능검사여대조조상비무현저성차이（ P＞0.05）。영양불량조여대조조비교，응혈매원시간、국제표준화비치연장，섬유단백원승고（ P＜0.05）；여영양정상조비교，상규응혈공능검사무현저성차이（P＞0.05）。（3）여대조조상비，MHD환자TEG반응시간（R치）연장，응혈지수（CI）부치증대，영양불량환자최대진폭（MA치）증대（P＜0.05）。영양불량조여영양정상조비교，MA치증대，CI부치증대（ P＜0.05）。결론 MHD환자상존재영양불량，응혈공능개변교위복잡，상규응혈공능결합TEG검사능구조기발현불동영양상황혈투환자응혈공능적이상。
Objective To assess blood coagulation of different nutritional status of maintenance hemodialysis(MHD)patients by thromboelastograph(TEG).Methods Thirty MHD patients were enrolled in this study and divided into two groups according to Subjective Global Assessment.Blood routine tests, serum biochemical indexes,conventional coagulation and TEG were measured.We also detected in 20 normal persons as control.Results (1) Hemoglobin,platelet and high-density lipoprotein in MHD patients were significant lower than those in the control group .The incidence of malnutrition was 46.6%.Serum albumin , pre-albumin and total cholesterol in malnutrition group were evidently lower than those in normal nutrition group (P<0.05).(2)There was no significant difference in conventional coagulation between normal nutrition group and control group ( P>0.05 ) .In malnutrition group,prothrombin time and international standardization ratio extended ,fibrinogen rose compared with the control(P<0.05);meanwhile,there was also no significant difference in conventional coagulation compared with normal nutrition group ( P>0.05 ) .( 3 ) There was significant difference in TEG parameters among three groups . Compared with the control , TEG reaction time ( R value ) extended , blood coagulation index ( CI ) negative value increased in MHD patients(P<0.05),and maximum amplitude(MA)increased in malnutrition group.Compared with normal nutrition group, MA value and CI negative value increased in malnutrition group ( P <0.05 ). Conclusion MHD patients often exist malnutrition ,change of their blood coagulation function is more complicated . Conventional coagulation combined with TEG can be used to detect early coagulation abnormalities of different nutritional status of MHD patients .