CAJ | 학술논문

目的：通过血栓弹力图（ TEG）动态检测，探讨TEG在骨科大手术围手术期抗凝治疗预防深静脉血栓（ DVT）中的监测作用。方法选择天津市天津医院2011年至2013年行膝关节置换术（ TKA）患者60例，男22例，女38例，年龄50～74岁。同期健康体检者42例，男24例，女18例，年龄45～75岁。患者按随机数字法分为低分子肝素（ LMWH）组，利伐沙班组，各30例。均采用常规剂量抗凝治疗，两组患者其余治疗均同常规治疗。 TEG（ R值、K值、Angle值、MA值、CI值）检测采用美国Haemoscope公司的TEG＠5000型血栓弹力图仪。应用美国GE LOGIQ 7型彩色多普勒超声诊断系统诊断有无DVT形成。使用SPSS17．0统计学软件分析实验数据，采用ROC曲线，敏感度、特异度、阳性预测值（ PPV）、阴性预测值（ NPV）评估TEG各参数对DVT的诊断价值。结果抗凝治疗终点利伐沙班组 TEG 的 Angle 值、 MA 值、 CI 值异常检出率（36．7％，46．7％，36．7％）均高于 LMWH 组（10．0％，20．0％，13．3％），差异均有统计学意义（χ2＝5．963，P＝0．015；χ2＝4．800，P＝0．028；χ2＝4．356，P＝0．037）。预测抗凝治疗终点发生DVT的临床诊断价值，CI、MA和Angle敏感度分别为75．0％、75．0％、62．5％，特异度分别为80．8％、76．9％、78．8％。以MA为68．35 mm作为抗凝治疗终点预测DVT发生的临床最佳诊断临界点。结论 TEG的R值可判断抗凝药物抗凝治疗后的有效性和安全性。（中华检验医学杂志，2015，38：333－336）
목적：통과혈전탄력도（ TEG）동태검측，탐토TEG재골과대수술위수술기항응치료예방심정맥혈전（ DVT）중적감측작용。방법선택천진시천진의원2011년지2013년행슬관절치환술（ TKA）환자60례，남22례，녀38례，년령50～74세。동기건강체검자42례，남24례，녀18례，년령45～75세。환자안수궤수자법분위저분자간소（ LMWH）조，리벌사반조，각30례。균채용상규제량항응치료，량조환자기여치료균동상규치료。 TEG（ R치、K치、Angle치、MA치、CI치）검측채용미국Haemoscope공사적TEG＠5000형혈전탄력도의。응용미국GE LOGIQ 7형채색다보륵초성진단계통진단유무DVT형성。사용SPSS17．0통계학연건분석실험수거，채용ROC곡선，민감도、특이도、양성예측치（ PPV）、음성예측치（ NPV）평고TEG각삼수대DVT적진단개치。결과항응치료종점리벌사반조 TEG 적 Angle 치、 MA 치、 CI 치이상검출솔（36．7％，46．7％，36．7％）균고우 LMWH 조（10．0％，20．0％，13．3％），차이균유통계학의의（χ2＝5．963，P＝0．015；χ2＝4．800，P＝0．028；χ2＝4．356，P＝0．037）。예측항응치료종점발생DVT적림상진단개치，CI、MA화Angle민감도분별위75．0％、75．0％、62．5％，특이도분별위80．8％、76．9％、78．8％。이MA위68．35 mm작위항응치료종점예측DVT발생적림상최가진단림계점。결론 TEG적R치가판단항응약물항응치료후적유효성화안전성。（중화검험의학잡지，2015，38：333－336）
Objective To investigate the effect of thrombelastography ( TEG ) monitoring on anticoagulation therapy in deep vein thrombosis ( DVT ) in the perioperative period of arthroplasty replacement through dynamic detecting of TEG.Methods 60 patients under went total knee arthroplasty ( TKA) were selected as the patient group from 2011 to 2013, Including 22 men and, 38 women, aging from 50 to 74 years old.These patients were divided into low molecular weight heparin ( LMWH ) group and rivaroxaban group according to random number table.Each group had 30 cases.Patients in both were all given routine dose anticoagulant drugs to prevent DVT.Other treatment were the same as conventional therapy for both group patients.Meannhile, 42 health examination participants were selected as the control group, 24 men and 18 women, aging from 45 to 75 years old.The parameters of TEG were measured by TEG@5000 thromboelastograph hemostasis system ( American Haemoscope Corporation).DVT was diagnosed by LOGIQ 7 color Doppler ultrasonic diagnostic apparatus of American GE Corporation. Data were analyzed by SPSS17.0.The predictive value of TEG on DVT was evaluated by receiver operating characteristic cure (ROC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV). Results Abnormal detection rates of Angle,MA,CI in rivaroxaban group(36.7%,46.7%,36.7%) were higher than LMWH group ( 10.0%, 20.0%, 13.3%) , and the differences between both groups all had statistical significance between both group(χ2 =5.963,P=0.015;χ2 =4.800,P=0.028;χ2 =4.356,P=0.037).CI , MA and Angle had better clinical diagnostic value on DVT.Their sensitivity was 75.0%, 75.0% and 62.5%, specificity respectively was 80.8%, 76.9%and 78.8%respectively.MA=68.35 mm <br> could be the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint.Conclusion TEG can monitor coagulation state of TKA patients, TEG′R can evaluate the safety and effectiveness of anticoagulation therapy on DVT.(Chin J Lab Med, 2015, 38:333-336)