血栓弹力图联合常规凝血检测对电烧伤患者创伤性凝血病的早期诊断价值

李全; 巴特; 曹胜军; 李芳; 闫增强; 侯智慧; 王凌峰

doi:10.3760/cma.j.cn501225-20240416-00135

血栓弹力图联合常规凝血检测对电烧伤患者创伤性凝血病的早期诊断价值

doi: 10.3760/cma.j.cn501225-20240416-00135

内蒙古医科大学第三附属医院烧伤外科,内蒙古烧伤医学研究所,包头　014010

基金项目:

内蒙古自治区卫生健康委员会公立医院科研联合基金科技项目 2023GLLH0245

内蒙古自然科学基金 2021MS08066

内蒙古医科大学联合项目 YKD2024LH015

详细信息

通讯作者:
王凌峰,Email：wlf7413@vip.sina.com

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出版历程
- 收稿日期: 2024-04-16

Diagnostic value of thromboelastography combined with conventional coagulation test for trauma-induced coagulopathy in patients with electric burns in the early stage

Department of Burn Surgery, the Third Affiliated Hospital of Inner Mongolia Medical University, Burn Medical Institute of Inner Mongolia, Baotou 014010, China

Funds:

Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Health Commission of Inner Mongolia Autonomous Region 2023GLLH0245

Inner Mongolia Natural Science Foundation 2021MS08066

Inner Mongolia Medical University Joint Project YKD2024LH015

More Information

Corresponding author: Wang Lingfeng, Email: wlf7413@vip.sina.com

摘要

摘要: 目的探讨血栓弹力图（TEG）联合常规凝血检测（CCT）对电烧伤患者创伤性凝血病（TIC）的早期诊断价值。方法该研究为回顾性病例系列研究。收集2018年2月—2024年2月内蒙古医科大学第三附属医院烧伤外科收治的符合入选标准的128例电烧伤患者和118例热力烧伤患者的临床资料,其中男224例、女22例,年龄（38±14）岁。按照伤情将患者分成电烧伤组（128例）与热力烧伤组（118例）,比较2组患者入院8 h内的TIC发生情况、CCT指标（凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原水平、D-二聚体水平、血小板计数）、TEG检测指标（凝血反应时间、K值、凝固角、最大血栓振幅、综合凝血指数、最大振幅后30 min振幅衰减率）。采用Kappa检验分析CCT和TEG诊断电烧伤患者伤后早期TIC的一致性。绘制CCT、TEG及TEG联合CCT诊断128例电烧伤患者发生TIC的受试者操作特征曲线,计算曲线下面积（AUC）、最大约登指数及此时的敏感度和特异度。结果入院8 h内,电烧伤组患者确诊TIC的比例为19.5%（25/128）,显著高于热力烧伤组的10.2%（12/118）,χ²=4.21,P<0.05。与热力烧伤组相比,电烧伤组患者入院8 h内凝血酶原时间显著缩短（t=-2.32,P<0.05）,D-二聚体水平、纤维蛋白原水平、血小板计数均显著升高（Z值分别为-2.11、-4.16,t=4.69,P<0.05）,凝血反应时间显著缩短（t=-2.51,P<0.05）,最大血栓振幅显著增大（t=2.50,P<0.05）,最大振幅后30 min振幅衰减率显著升高（t=2.10,P<0.05）；2组患者其余CCT指标和TEG检测指标比较,差异均无统计学意义（P>0.05）。CCT和TEG诊断电烧伤患者伤后早期TIC具有高度一致性（Kappa=0.63,P<0.05）。TEG联合CCT、TEG、CCT诊断128例电烧伤患者发生TIC的受试者操作特征曲线的AUC分别为0.92、0.84、0.77（95%置信区间分别为0.86~0.97、0.71~0.97、0.71~0.97）,最大约登指数分别为0.86、0.57、0.65,此时的特异度分别为93.7%、83.2%、88.2%,敏感度分别为92.3%、87.5%、76.5%。结论电烧伤患者伤后早期处于凝血系统高凝和纤维溶解系统亢进状态,TEG联合CCT可提高电烧伤患者TIC诊断率。
- 烧伤,电 /
- 血栓弹力图 /
- 常规凝血检测 /
- 创伤性凝血病
Abstract: Objective To explore the diagnostic value of thromboelastography (TEG) combined with conventional coagulation test (CCT) for trauma-induced coagulopathy (TIC) in patients with electric burns in the early stage. Methods This study was a retrospective case series research. From February 2018 to February 2024, the clinical data of 128 electric burn patients and 118 thermal burn patients who met the inclusion criteria and admitted to the Department of Burn Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University were collected, including 224 males and 22 females, aged (38±14) years. The patients were divided into electric burn group (128 cases) and thermal burn group (118 cases) according to their injuries. The incidence of TIC, the indicators of CCT, including prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, D-dimer level, platelet count, and the detection indicators of TEG, including coagulation reaction time, K value, coagulation angle, maximum thrombus amplitude, comprehensive coagulation index, and lysis rate at 30 minutes after maximum amplitude within 8 hours of admission were compared between the two groups of patients. The Kappa test was used to analyze the consistency between CCT and TEG in diagnosing TIC in patients with electric burns in the early stage after burns. The receiver operating characteristic curves of CCT, TEG, and TEG combined with CCT in diagnosing TIC in 128 patients with electric burns were drawn, and the area under the curve (AUC), the maximum Jordan index, and sensitivity and specificity at this time were calculated. Results The proportion of patients diagnosed with TIC in electric burn group was 19.5% (25/128) within 8 hours of admission, which was significantly higher than 10.2% (12/118) in thermal burn group (χ²=4.21, P<0.05). Compared with those in thermal burn group, prothrombin time was significantly shortened (t=-2.32, P<0.05), D-dimer level, fibrinogen level, and platelet count were significantly increased (with Z values of -2.11 and -4.16, respectively, t=4.69, P<0.05), the coagulation reaction time was significantly shortened (t=-2.51, P<0.05), and the maximum thrombus amplitude and lysis rate at 30 minutes after the maximum amplitude were significantly increased (with t values of 2.50 and 2.10, respectively, P<0.05) in patients in electric burn group within 8 hours of admission. There were no statistically significant differences in the other CCT indicators and TEG detection indicators between the two groups of patients (P>0.05). The CCT and TEG showed high consistency in the diagnosis of TIC in patients with electric burns in the early stage after burns (Kappa=0.63, P<0.05). The AUCs of TEG combined with CCT, TEG, and CCT in diagnosis of TIC in 128 patients with electric burns were 0.92, 0.84, and 0.77 (with 95% confidence intervals of 0.86-0.97, 0.71-0.97, and 0.71-0.97, respectively), with the maximum Jordan indexes of 0.86, 0.57, and 0.65. At this time, the specificity was 93.7%, 83.2%, and 88.2%, respectively, and the sensitivity was 92.3%, 87.5%, and 76.5%, respectively. Conclusions Patients with electric burns are in a state of hypercoagulability of coagulation system and hyperfunction of fibrinolysis system in the early stage after burns, and TEG combined with CCT can increase the diagnostic rate of TIC in patients with electric burns.
- Burns, electric /
- Thromboelastography /
- Conventional coagulation test /
- Trauma-induced coagulopathy
李全：初稿撰写,资料收集,统计分析；巴特：研究设计,经费支持；曹胜军、李芳：数据收集,统计分析；闫增强、侯智慧：资料整理,论文修改；王凌峰：研究设计,论文审查

所有作者均声明不存在利益冲突

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图 1 不同凝血功能检测方式诊断128例电烧伤患者发生创伤性凝血病的受试者操作特征曲线

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Table 1. 电烧伤组与热力烧伤组患者临床资料比较

组别	例数	性别（例）		年龄（岁,x¯±s）	烧伤总面积[%TBSA,M（Q₁,Q₃）]	Ⅲ度烧伤面积[%TBSA,M（Q₁,Q₃）]	Ⅳ度烧伤面积[%TBSA,M（Q₁,Q₃）]	总住院时间[d,M（Q₁,Q₃）]	合并吸入性损伤（例）	APACHEⅡ评分（分,x¯±s）	ABSI评分（分,x¯±s）	入院8 h内确诊TIC（例）
组别	例数	男	女	年龄（岁,x¯±s）	烧伤总面积[%TBSA,M（Q₁,Q₃）]	Ⅲ度烧伤面积[%TBSA,M（Q₁,Q₃）]	Ⅳ度烧伤面积[%TBSA,M（Q₁,Q₃）]	总住院时间[d,M（Q₁,Q₃）]	合并吸入性损伤（例）	APACHEⅡ评分（分,x¯±s）	ABSI评分（分,x¯±s）	入院8 h内确诊TIC（例）
电烧伤组	128	118	10	37±14	8.00（5.00,11.00）	4.00（2.00,7.00）	1.00（0,2.00）	23.00（14.75,33.00）	11	11±4	9±4	25
热力烧伤组	118	106	12	39±15	10.00（6.00,12.00）	5.00（2.00,8.00）	2.00（0,4.00）	16.00（12.00,32.00）	15	10±4	10±4	12
统计量值		χ²=0.42		t=-1.32	Z=-2.16	Z=-1.66	Z=0.48	Z=-2.04	χ²=1.10	t=1.39	t=-1.23	χ²=4.21
P值		0.508		0.302	0.031	0.098	0.632	0.042	0.294	0.167	0.219	0.040
注：TBSA为体表总面积,APACHEⅡ为急性生理学和慢性健康状况评价Ⅱ,ABSI为简明烧伤严重指数,TIC为创伤性凝血病

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Table 2. 电烧伤组与热力烧伤组患者入院8 h内的常规凝血检测指标比较

组别	例数	PT（s,x¯±s）	APTT（s,x¯±s）	TT（s,x¯±s）	D-二聚体[μg/mL,M（Q₁,Q₃）]	FIB[g/L,M（Q₁,Q₃）]	血小板计数（×10⁹/L,x¯±s）
电烧伤组	128	10±4	27±8	16±5	1.88（0.93,3.38）	5.40（4.09,6.48）	184±11
热力烧伤组	118	11±5	27±8	16±5	1.60（0.71,2.57）	4.28（3.21,5.40）	166±9
统计量值		t=-2.32	t=-0.77	t=-0.85	Z=-2.11	Z=-4.16	t=4.69
P值		0.021	0.445	0.398	0.035	<0.001	<0.001
注：PT为凝血酶原时间,APTT为活化部分凝血活酶时间,TT为凝血酶时间,FIB为纤维蛋白原

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Table 3. 电烧伤组与热力烧伤组患者入院8 h内的血栓弹力图指标比较

组别	例数	凝血反应时间（min,x¯±s）	K值[min,M（Q₁,Q₃）]	凝固角（°, x¯±s）	最大血栓振幅（mm,x¯±s）	最大振幅后30 min振幅衰减率（%, x¯±s）	综合凝血指数[M（Q₁,Q₃）]
电烧伤组	128	8±3	3.17（1.12,5.50）	65±15	64±15	5.5±2.0	3.50（0.78,6.40）
热力烧伤组	118	9±4	3.64（1.30,5.42）	62±16	59±16	5.0±2.2	3.10（-1.20,5.90）
统计量值		t=-2.51	Z=-0.53	t=1.04	t=2.50	t=2.10	Z=-1.39
P值		0.013	0.597	0.297	0.013	0.037	0.165