血栓弹力图在评价不同营养状况血液透析患者凝血功能中的作用

··杨松涛孙克冰吴虹肖跃飞DOI10.3877/[e-mail]【】TEG。30MHD20、、、、、TEG。。1MHD、、。46.6%、、P＜0.05。2P＞0.05。、P＜0.05P＞0.05。3MHDTEGRCIMAP＜0.05。MACIP＜0.05。MHDTEG。【】ThromboelastographinevaluationofbloodcoagulationofdifferentnutritionalstatusofhemodialysispatientsYANGSong-taoSUNKe-bingWUHongXIAOYue-fei．DepartmentofNephrologyAerospaceCentralHospitalAerospaceClinicalMedicalCollegeofPekingUniversit[e-mail]【Abstract】ObjectiveToassessbloodcoagulationofdifferentnutritionalstatusofmaintenancehemodialysisMHDpatientsbythromboelastographTEG．MethodsThirtyMHDpatientswereenrolledinthisstudyanddividedintotwogroupsaccordingtoSubjectiveGlobalAssessment．BloodroutinetestsserumbiochemicalindexesconventionalcoagulationandTEGweremeasured．Wealsodetectedin20normalpersonsascontrol．Results1Hemoglobinplateletandhigh-densitylipoproteininMHDpatientsweresignificantlowerthanthoseinthecontrolgroup．Theincidenceofmalnutritionwas46.6%．Serumalbuminpre-albuminandtotalcholesterolinmalnutritiongroupwereevidentlylowerthanthoseinnormalnutritiongroupP＜0.05．2TherewasnosignificantdifferenceinconventionalcoagulationbetweennormalnutritiongroupandcontrolgroupP＞0.05．InmalnutritiongroupprothrombintimeandinternationalstandardizationratioextendedfibrinogenrosecomparedwiththecontrolP＜0.05meanwhiletherewasalsonosignificantdifferenceinconventionalcoagulationcomparedwithnormalnutritiongroupP＞0.05．3TherewassignificantdifferenceinTEGparametersamongthreegroups．ComparedwiththecontrolTEGreactiontimeRvalueextendedbloodcoagulationindexCInegativevalueincreasedinMHDpatientsP＜0.05andmaximumamplitudeMAincreasedinmalnutritiongroup．ComparedwithnormalnutritiongroupMAvalueandCInegativevalueincreasedinmalnutritiongroupP＜0.05．ConclusionMHDpatientsoftenexistmalnutritionchangeoftheirbloodcoagulationfunctionismorecomplicated．ConventionalcoagulationcombinedwithTEGcanbeusedtodetectearlycoagulationabnormalitiesofdifferentnutritionalstatusofMHDpatients．【Keywords】RenaldialysisThrombelastographyBloodcoagulationMHD1-2。MHD3。TEG4。TEG·9473·2013579ChinJCliniciansElectronicEditionMay12013Vol．7No．9。、20124MHD。1＞18233、、451、。30181260.5±12.35～17840.6。139413。、20。。、1．4008B14L1.4m234h250～300ml/min500ml/min。。2．MHD、TEGTEG5000Haemoscope2h。Hb、PLT。PT、INR、APTT、Fib、D-D-dimer、TT。ALB、pre-ALB、TC、TG、HDL、LDL、Scr、Kt/V。SGA。SGA、、、5。ABC5。3．TEG1。、SPSS13.0±珋x±sLSD-t。MQ1～Q3。。P＜0.05。1．MHDHb、PLT、HDL。SGA。1653.3%141033.3%413.3%。ALB、preALB、TCP＜0.05、、Hb、PLT、Kt/VP＞0.051。2．MHDPT、INR、APTT、Fib、D-dimer、TTP＞0.05。PT、INRFibP＜0.05P＞0.05。2。3．TEGMHDRCIMAP＜0.05。MHDMACIP＜0.05。3。MHD23%～76%6%～8%6。SGAMHD46.6%。MHD、、、、7。PT、INRFib。PT。PTⅠ、Ⅴ、Ⅶ、Ⅹ8。PT。K9-10KK。Fib。·0573·2013579ChinJCliniciansElectronicEditionMay12013Vol．7No．91MHD珋x±s/Hbg/L珋x±sPLT×109/L珋x±sALBg/L珋x±spreALBg/L珋x±s2057.4±14.710/10136.0±14.4222.2±59.738.9±3.80.35±0.21MHD1661.3±10.210/6107.6±20.3a124.9±36.8a39.2±4.40.52±0.671458.6±13.78/6103.8±18.5a137.1±32.9a34.6±10.7ab0.33±0.18bScrμmol/L珋x±sTGmmol/L珋x±sTCmmol/L珋x±sHDLmmol/L珋x±sLDLmmol/L珋x±sKt/V珋x±s2067.5±10.31.36±0.634.01±0.731.57±0.322.64±0.82－MHD16728.9±284.6a1.66±1.274.82±1.260.98±0.24a3.13±1.04a1.34±0.2614793.6±321.5a1.48±1.363.57±0.79b1.00±0.32a2.28±0.721.63±0.27MHDHbPLTALBpreALBScrTGTCHDLLDLKt/V。aP＜0.05bP＜0.052MHD珋x±sPTsINRAPTTsFibg/LD-dimerng/mlTTs2010.6±1.10.9±0.131.8±3.52.9±0.6294±170.516.2±1.3MHD1611.1±0.61.0±0.133.6±3.03.2±0.8308.7±202.415.0±1.81411.1±0.8a1.0±0.1a32.9±2.53.8±0.9a267.4±146.814.0±1.1MHDPTINRAPTTFibD-dimerD-TT。aP＜0.053MHDTEGRmin珋x±sKmin珋x±sα-angle珋x±sMAmm珋x±sCIMQ1～Q3206.2±1.32.0±0.660.8±7.359.8±6.5－0.6－3.8～2.7MHD168.0±1.4a2.0±0.760.1±8.458.7±5.4－2.1－5.6～1.1a147.8±1.3a1.7±0.563.6±7.964.7±7.1ab－0.1－4.6～1.6abMHDRα-angleαKMACI。aP＜0.05bP＜0.05。TEG。。TEG11。TEGRTEG2mm。KR20mm。αK。MA。CI－3～3＞+3＜－3。RCIPT、INRK。TEG。MA、vW、。Darlington12MHDTEG31%RMA42.9%41.4%。。·1573·2013579ChinJCliniciansElectronicEditionMay12013Vol．7No．9MHDTEG。1ZygaSChristopoulouGMalliarouM．Malnutrition-inflammation-ath-erosclerosissyndromeinpatientswithend-stagerenaldisease．JRenCare20113712-15．2．、J/CD．201269-12．3．．20087335-337．4ChandlerWL．Thethromboelastographyandthethromboelastographtechnique．SeminThrombHemost1995211-6．5DetskyASMcLaughlinJRBakerJPetal．WhatissubjectiveglobalassessmentofnutritionalstatusJPENJParenterEnteralNutr1987118-13．6ZeierM．Riskofmortalityinpatientswithendstagerenaldiseasetheroleofmalnutritionandpossibletherapeuticimplications．HormRes200258Suppl330-34．7AmaralSHwangWFivushBetal．Serumalbuminlevelandriskformortalityandhospitalizationinadolescentsonhemodialysis．ClinJAmSocNephrol20083759-767．8．．3．201196-97．9CranenburgECSchurgersLJUiterwijkHHetal．VitaminKintakeandstatusarelowinhemodialysispatients．KidneyInt201282605-610．10PilkeyRMMortonARBoffaMBetal．SubclinicalvitaminKdefi-ciencyinhemodialysispatients．AJKD200749432-439．11CuiYHeiFLongCetal．Perioperativemonitoringofthromboelasto-graphonbloodprotectionandrecoveryforseverelycyanoticpatientsundergoingcomplexcardiacsurgery．ArtifOrgans201034955-960．12DarlingtonAFerreiroJLUenoMetal．Haemostaticprofilesasses