【摘要】 目的 探讨血栓弹力图(thromboelastography, TEG)在深静脉血栓(deep vein thrombosis, DVT)形成中的临床价值。方法 收集在作者医院确诊的142例DVT患者。评估TEG参数和传统凝血功能检测(conventional coagulation tests, CCTs)指标在DVT中的应用，其中TEG参数包含R值、K值、Angle值、MA值、CI值、G值，CCTs指标包含血小板计数(platelet, PLT)、凝血酶原时间(prothrombin time, PT)、PT%、国际标准化比值(international normalized ratio, INR)、活化部分凝血酶时间(activated partial thrombin time, APTT)、凝血酶时间(thrombin time, TT)、纤维蛋白原浓度(fibrinogen, FIB)、D-二聚体(D-dimer, D-D),分析TEG的临床价值。结果 DVT患者的R值与APTT、TT呈正相关(r系数分别为0.289、0.337,P均<0.01);K值与TT呈正相关(r=0.375,P<0.05),与PLT和FIB呈负相关(r=-0.434、-0.503,P均<0.01);Angle值、MA值分别与PLT和FIB呈正相关(r系数分别为0.437、0.508;r系数分别为0.382、0.469,P均<0.01),而与TT呈负相关(r系数分别为-0.353、-0.348,P均<0.01)。TEG对低凝和高凝状态的检出率分别为23.94%、6.34%,而CCTs指标分别为3.52%、1.41%,其检出率比较差异有统计学意义(P<0.01)。TEG中R值判断PT>14 s的曲线下面积(area under the curve, AUC)为0.671;K值预测PLT<125×10~9/L的AUC为0.709;Angle值和MA值均对TT<14 s、FIB>4 g/L显示的高凝状态有预测价值。结论 TEG和CCTs指标检测在DVT中的相关性较弱，但更易检出DVT患者凝血状态的改变。TEG检测将有助于推动DVT患者的精准化抗凝治疗。更多还原

【Abstract】 Objective To explore the clinical application value of thromboelastography(TEG) in deep vein thrombosis(DVT). Methods A total of 142 patients with DVT were involved. The correlation and consistency between TEG(R value, K value, Angle value, MA value, CI value, G value) and conventional coagulation tests(CCTs), including platelet(PLT), prothrombin time(PT), PT%, international normalized ratio(INR), activated partial thrombin time(APTT), thrombin time(TT), fibrinogen(FIB), D-dimer(D-D) in DVT patients were evaluated, the clinical value of TEG was analyzed. Results The R value of DVT patients was positively correlated with APTT and TT(r=0.289, 0.337, all P<0.01); K value was positively correlated with TT(r=0.375, P<0.01), but negatively correlated with PLT and FIB(r=-0.434,-0.503, all P<0.01); Angle value and MA value were positively correlated with the PLT and FIB(r=0.437, 0.508; r=0.382, 0.469, all P<0.01), but was negatively correlated with the TT(r=-0.353,-0.348, all P<0.01). The detection rates of TEG for hypocoagulable and hypercoagulable states were 23.94% and 6.34% respectively, while the CCTs indexes were 3.52% and 1.41% respectively, and the difference in detection rates was statistically significant(P<0.01). The area under the curve(AUC) of R value to judge PT>14 s was 0.671; the AUC of K value for predicting PLT<125×10~9/L was 0.709; Angle value and MA value had predictive value for the hypercoagulable state shown by TT<14 s, FIB>4 g/L. Conclusion The correlation between TEG and CCTs in DVT are weak, but TEG is easier to detect changes in the coagulation status of DVT patients. TEG will help promote accurate anticoagulation therapy for DVT patients.更多还原