【摘要】 目的 探讨血栓弹力图(thrombelastography, TEG)评估过敏性紫癜(henoch-sch9nlein purpura, HSP)患儿凝血状态中的临床价值。方法 前瞻性连续收集2020年9月～2021年9月在新疆医科大学第一附属医院首次确诊为HSP患儿80例(病例组)和同期来院体检的健康儿童45例(对照组),对两组进行TEG与常规凝血检测，并对病例组进行远期随访，观察紫癜性肾炎(Henoch-Sch9nlein purpura nephritis, HSPN)发生率，进一步分析TEG对HSPN患儿高凝状态的诊断效能。结果 病例组R值、K值均显著降低(P<0.05),而D-二聚体、Fib、α角则显著增大(P<0.05)。对TEG和常规凝血指标进行相关性分析发现，R值和APTT间呈正相关；K值和Fib间呈负相关；α角和APTT间呈负相关。随访6个月内，TEG阳性组患儿HSPN发生率为35.00%(28/80),显著高于TEG阴性组。D-二聚体、Fib、α角、K值和R值的敏感度分别为63.33%、20.00%、83.33%、70.00%和73.33%;特异性分别为55.10%、97.96%、60.00%、58.00%和66.00%。在所有单项指标中，相比其他指标α角敏感度和特异性较高，约登指数最高。结论 TEG在评价HSP患儿高凝状态中有重要的作用；早期TEG呈高凝状态的HSP患儿中HSPN发生率较高，相较于D-二聚体和Fib, TEG对确定高凝状态有更好的诊断价值，对预测HSP患儿肾脏损害有一定价值。更多还原

【Abstract】 Objective To investigate the clinical value of thrombelastography(TEG) in predicting renal injury in children with Henoch-Sch?nlein purpura(HSP). Methods Prospective continuous collection of 80 children with HSP(case group) and 45healthy children(control group) who came to the hospital for physical examination from September 2020 to September 2021 in the First Affiliated Hospital of Xinjiang Medical University. Thrombelastogram, routine coagulation function and D-dimer were detected in the two groups, and the case group was followed up for long-term periods. The incidence of henoch-Sch?nlein purpura nephritis(HSPN) was examined, and the diagnostic efficiency of TEG for hypercoagulable state in children with HSPN was further analyzed. Results the R and K of the case group were significantly decreased(P<0.05), while the D-dimer, Fib and ɑ angle were significantly increased(P<0.05). The correlation analysis between TEG and conventional coagulation indexes showed that there was a positive correlation between R and APTT. There was a negative correlation between K and Fib; there was a negative correlation between ɑ angle and APTT. Within six months of follow-up, the incidence of HSPN in the TEG positive group was 35.00%(28/80), which was significantly higher than that in the TEG negative group. The sensitivity of D-dimer, Fib, αangle, K and R was 63.33%, 20.00%, 83.33%, 70.00% and 73.33%, respectively. The specificity was 55.10%, 97.96%, 60.00%, 58.00% and 66.00%, respectively. Among all individual indicators, the sensitivity and specificity of αangle were higher than those of other indicators, and the Yordon index was the highest. Conclusion TEG might play an important role in evaluating hypercoagulable state in children with HSP. The incidence of HSPN in children with early TEG hypercoagulable state was higher. Compared with D-dimer and Fib, TEG had better diagnostic value for determining hypercoagulable state and had certain value for predicting renal damage in children with HSP.更多还原