TEG在过敏性紫癜患儿凝血功能及病情评估中的应用研究

Study on the Application of Thromboelastography in the Assessment of Coagulation Function and Condition of Children with Henoch-Schönlein Purpura

摘要: 目的：探讨血栓弹力图(TEG)对过敏性紫癜患儿凝血功能的评价作用及其病情严重程度评估方面的意义。方法：选取2023年4月~2024年8月在我院儿科收治的符合标准的44例过敏性紫癜患者为病例组，同时选择我院门诊健康体检的儿童42例作为对照组，对两组进行TEG与常规凝血检测，并对病例组进行紫癜症状评分，对比两组的检测结果差异，探讨病例组TEG各项参数与常规凝血功能指标的关联性及敏感性，评估各参数与病情的相关性。结果：相较于对照组，病例组的α角、MA值、LY30、Fib及D-D水平显著升高，而R值和K值则显著降低，以上差异均具有统计学意义(P < 0.05)，分析病例组TEG和CCT中同类指标的相关性，发现Fib水平与α角呈正相关关系(r = 0.36, P < 0.05)，Fib与K值呈负相关(r=−0.34, P < 0.05)，R值与PT、APTT间呈正相关(r = 0.32, P < 0.05, r = 0.52, P < 0.01)。TEG参数α角评价HSP高血凝状态敏感性显著高于传统凝血指标Fib，在纤溶亢进状态的检出率方面，D-二聚体敏感性高于TEG参数LY30。α角、D-二聚体与紫癜症状评分均呈正相关(r = 0.827, P < 0.001, r = 0.320, P < 0.05)，K值和评分呈负相关(r = −0.588, P < 0.001)。结论：TEG与CCT检测在反映过敏性紫癜凝血功能方面各有优势，二者不能完全取代；TEG参数与过敏性紫癜病情严重程度具有显著相关性，对临床具有重要的参考价值。

Abstract: Objective: To investigate the role of thromboelastography (TEG) in the assessment of coagulation in children with Henoch-Schönlein purpura (HSP) and its relevance to the assessment of disease severity. Methods: 44 patients with HSP admitted to the Pediatrics Department of our hospital from April 2023 to August 2024 who met the criteria were selected as the case group, and 42 children who underwent outpatient health checkups in our hospital were selected as the control group, and TEG and Conventional coagulation test (CCT) were performed on the two groups and purpura symptom scoring was performed on the case group, and the differences in the results between the two groups were compared to explore the correlation and sensitivity of the various parameters of TEG and conventional coagulation test of the case group, and to assess the correlation between each parameter and the condition. The correlation between the indexes of thromboelastography in the case group and the indexes of Conventional coagulation test and their sensitivity, and assess the correlation between each parameter and the condition. Results: Compared with the control group, the α-angle, MA value, LY30, Fib and D-D levels in the case group were significantly higher, while the R and K values were significantly lower, and all of these differences were statistically significant (P < 0.05). Analysing the correlation of similar indexes in the TEG and CCT of the case group, it was found that the Fib level had a positive correlation with the α-angle (r = 0.36, P < 0.05), Fib and K-value were negatively correlated (r=−0.34, P < 0.05), and the correlation between R-value and PT and APTT was found to be positive (r = 0.32, P < 0.05, r = 0.52, P < 0.01). The sensitivity of α-angle in evaluating the hypercoagulable state of HSP with the TEG parameter was significantly higher than that of traditional coagulation index Fib, and in the detection rate of the hyper fibrinolytic state, the D-dimer sensitivity was higher than that of TEG parameter LY30. LY30. α-angle, D-dimer and purpura symptom score were positively correlated (r = 0.827, P < 0.001, r = 0.320, P < 0.05), and K value and score were negatively correlated (r = −0.588, P < 0.001). Conclusion: TEG and CCT have their own advantages in reflecting the coagulation function of HSP, and they cannot be completely replaced; TEG parameters have a significant correlation with the severity of HSP, which is an important reference value for the clinic.