血栓弹力图在评估肺部感染患者凝血状态中的研究现状

Research Status of Thromboelastography in Evaluating the Coagulation Status of Patients with Pulmonary Infection

摘要: 肺部感染通常是指肺部受到细菌、真菌、病毒等各种感染所致肺泡、肺间质或终末气道发生炎症性改变的疾病。肺部感染常并发凝血功能紊乱，是导致病情进展及不良预后的关键因素。传统的凝血功能检测指标如凝血酶原时间、活化部分凝血活酶时间及D-二聚体等，在评估肺部感染患者复杂的凝血状态时特异性较差，易受年龄、性别、手术、肿瘤等因素的影响，存在一定局限性。血栓弹力图(Thrombelastography, TEG)通过血栓弹力仪绘制动态变化的血液凝固图像，得到反应时间(Reaction Time, R)、凝固时间(Kinetics Time, K)、最大振幅(Maximum Amplitude, MA)、α角(Alpha Angle, α)、凝血综合指数(Coagulation Index, CI)等指标，可反映血液凝固的动态变化。近年的研究表明，血栓弹力图在指导抗凝、评估预后等方面发挥了重要作用。文章旨在系统综述血栓弹力图在评估肺部感染患者凝血状态中的研究现状，以期为临床精准评估与管理肺部感染患者的凝血功能提供新的思路和依据。

Abstract: Pulmonary infection refers to inflammation of the alveoli, lung interstitium, or terminal airways induced by infections (e.g., bacteria, fungi, viruses). It is often complicated by coagulation dysfunction, a key driver of disease progression and poor prognosis. Traditional coagulation tests (e.g., prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer) lack specificity in assessing the complex coagulation status of these patients and are susceptible to confounding factors (e.g., age, gender, surgery, tumors), with inherent limitations. Thromboelastography (TEG) traces the time-dependent viscoelastic changes of a developing clot, yielding parameters such as reaction time (R), kinetics time (K), maximum amplitude (MA), alpha angle (α), and the coagulation index (CI), reflecting the dynamic changes in blood coagulation. Recent studies have highlighted its critical role in guiding anticoagulant therapy and prognostic evaluation. This article systematically reviews the research progress of TEG in evaluating coagulation function in patients with pulmonary infection, aiming to provide novel insights and evidence for the clinically accurate assessment and management of coagulation disorders in this population.