南水北调核心水源区健康人群血栓弹力图参考区间的建立及应用

doi:10.3760/cma.j.issn.1007-1245.2023.20.012

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (20): 2878-2882.DOI: 10.3760/cma.j.issn.1007-1245.2023.20.012

南水北调核心水源区健康人群血栓弹力图参考区间的建立及应用

许词¹ 杨讯¹ 闫彬² 任东方² 贾彦巍²

¹南阳市中心医院输血科，南阳　473000；²南阳市中心医院医学检验科，南阳　473000

收稿日期:2022-12-17 出版日期:2023-10-15 发布日期:2023-11-06
通讯作者: 闫彬，Email：sudayanbin@163.com
基金资助:
河南省重点研发与推广专项科技攻关项目（212102310805）；河南省和国家卫健委省部共建青年项目（SBGJ202103109）；南阳市重点研发与推广专项科技攻关项目（KJGG139、KJGG140）

Establishment and application of reference interval of thromboelastography for healthy people in core water source area of South-to-North Water Diversion Project

Xu Ci¹, Yang Xun¹, Yan Bin², Ren Dongfang², Jia Yanwei²

¹Department of Blood Transfusion, Nanyang Central Hospital, Nanyang 473000, China; ²Department of Clinical Laboratory Medicine, Nanyang Central Hospital, Nanyang 473000, China

Received:2022-12-17 Online:2023-10-15 Published:2023-11-06
Contact: Yan Bin, Email: sudayanbin@163.com
Supported by:
Scientific and Technological Problem-tackling Project of Key Special Program of Research, Development, and Promotion in Henan (212102310805); Provincial and Ministerial Youth Program of Henan Province and National Health Commission (SBGJ202103109); Scientific and Technological Problem-tackling Project of Key Special Program of Research, Development, and Promotion in Nanyang (KJGG139 and KJGG140)

摘要/Abstract

摘要：

目的　建立南水北调核心水源区健康人群的血栓弹力图参考区间，为本地区疾病的诊断和治疗提供有效依据。方法　本研究为前瞻性研究，选取2021年10月至2022年6月河南南阳地区160名健康志愿者为研究对象，按照《临床实验室检验项目参考区间的制定》（WS/T402-2012）的标准方法，采集外周静脉血，分别运用血凝仪和血栓弹力图仪对常规凝血、纤溶指标进行测定，包括D-二聚体（DD）、凝血酶原时间（PT）、纤维蛋白原（FIB）、凝血酶时间（TT）以及活化部分凝血活酶时间（APTT）和血栓弹力图参数［凝血反应时间（R）、血细胞凝集成块时间（K）、血细胞凝集成块速率（α角）、凝血块的最大强度（MA）、凝血综合指数（CI）］，然后计算95%置信区间，确定TEG各个参数的参考区间。组间比较采用t检验、非参数检验，采用Spearman秩相关性分析。结果　160例研究对象中，男107例、女53例，年龄（54.2±10.4）岁。男性和女性的常规凝血、纤溶指标检测结果差异均无统计学意义（均P>0.05）；本研究建立的血栓弹力图各参数的正常参考范围分别为：R 5.06~10.06 min；K 1.41~4.22 min；α角41.81°~70.50°；MA 48.03~67.69 mm；CI -5.50~1.40；与女性TEG参数相比，男性的K值显著升高［（2.54±0.70）比（2.96±0.70），t=3.70，P<0.01］，而α角和CI值则显著降低［（56.34±7.18）比（52.21±6.57），t=-3.53，P<0.01；（-2.02±1.94）比（-2.93±1.72），t=-2.88，P<0.01］；相关性分析发现R值与APTT呈正相关（r=0.26，P<0.01），K与FIB呈负相关（r=-0.28，P<0.01），与TT呈正相关（r=0.26，P<0.01），α角与TT呈负相关（r=-0.25，P<0.01），α角、MA、CI与FIB呈正相关（r=0.24，P<0.01；r=0.49，P<0.01；r=0.25，P<0.01），CI与TT、APTT呈负相关（r=-0.19，P=0.02；r=-0.19，P=0.02）。结论　南阳健康人群血栓弹力图参考区间与厂家提供的参考范围存在区别，有必要建立本地区血栓弹力图的参考范围，其能为疾病的诊断和治疗提供精准结果，但血栓弹力图无法代替传统的凝血项目检测。

关键词:

血栓弹力图, 凝血四项, 参考区间

Abstract:

Objective　To establish the reference interval of thromboelastography for healthy people in the core water source area of the South-to-North Water Diversion Project, and provide an effective basis for the diagnosis and treatment of diseases in this area. Methods　This is a prospective study. One hundred and sixty healthy volunteers in Nanyang City from October 2021 to June 2022 were included. Their peripheral venous blood was collected according to the standard method of Reference Intervals of Clinical Laboratory Test Items (WS/T402-2012). Thromboelastography was used to measure the conventional coagulation and fibrinolysis indicators, including D-dimer (DD), prothrombin time (PT), fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT), and TEG parameters [coagulation reaction time (R), hemagglutination time (K), hemagglutination velocity (α angle), maximum strength (MA), and comprehensive index (CI)]; the 95% confidence interval was calculated to determine the reference interval of each parameter of thromboelastography. Comparisons between the two groups were made by the t test and non-parameter test. The results of Spearman's rank correlation analysis were used for the correlation analysis. Results　Of the 160 study subjects, 107 were male and 53 were female, with an age of (54.2±10.4) years. There were no statistical differences in the conventional coagulation and fibrinolysis indicators between the males and the females (all P>0.05). The normal reference ranges of thromboelastography parameters established were as below: R 5.06-10.06 min, K 1.41-4.22 min, α angle 41.81°-70.50°, MA 48.03-67.69 mm, and CI -5.50-1.40. Compared with the thromboelastography parameters of the females, the K value of the males was significantly higher [(2.54±0.70) vs. (2.96±0.70); t=3.70, P<0.01], while the α angle and CI values were significantly lower [(56.34±7.18)° vs. (52.21±6.57)° and (-2.02±1.94) vs. (-2.93±1.72); t=-3.53 and -2.88, both P<0.01]. The R value was positively correlated with APTT (r=0.26, P<0.01), K negatively with FIB (r=-0.28, P<0.01) and positively with TT (r= 0.26, P<0.01), α angle negatively with TT (r=-0.25, P<0.01), α angle, MA, and CI positively with FIB (r=0-24, P<0.01; r=0.49, P<0.01; r=0.25, P<0.01), and CI negatively with TT and APTT (r=-0.19, P=0.02; r=-0.19, P=0.02). Conclusions　The reference range of thrombelastography in healthy population in Nanyang is still different from the reference range provided by the manufacturer. It is necessary to establish the reference range of thrombelastography in this area. It can provide accurate results for the diagnosis and treatment of diseases, but thromboelastography cannot replace the traditional coagulation test.

Key words:

Thromboelastography, Four items of coagulation, Reference interval

许词杨讯闫彬任东方贾彦巍.

南水北调核心水源区健康人群血栓弹力图参考区间的建立及应用 [J]. 国际医药卫生导报, 2023, 29(20): 2878-2882.

Xu Ci, Yang Xun, Yan Bin, Ren Dongfang, Jia Yanwei.

Establishment and application of reference interval of thromboelastography for healthy people in core water source area of South-to-North Water Diversion Project [J]. International Medicine and Health Guidance News, 2023, 29(20): 2878-2882.

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南水北调核心水源区健康人群血栓弹力图参考区间的建立及应用

Establishment and application of reference interval of thromboelastography for healthy people in core water source area of South-to-North Water Diversion Project

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