目的:评估采用血栓弹力图(thrombela-stograghy, TEG)对接受双重血浆分子吸附(double plasma molecular absorb system, DPMAS)联合血浆置换(plasmapheresis, PE)治疗的慢加急性肝衰竭(acute on chronic liver failure, ACLF)患者的凝血功能变化的监测效果。方法:选择2021年1月-2024年1月宁夏医科大学总医院收治的49例行DPMAS联合PE治疗的ACLF患者作为研究对象,在治疗前后进行TEG和常规凝血项目检测,收集患者的临床资料和凝血指标进行统计学分析。采用Pearson法评估TEG参数与常规凝血指标之间的相关性,并通过ROC曲线探讨TEG单项及联合参数对ACLF患者预后的预测能力。结果:与治疗前比较,DPMAS联合PE模式治疗ACLF患者的临床特征以及部分实验室指标之间差异具有统计学意义(P＜0.05)。TEG检测结果的R值减小,凝血指数显著升高(P=0.001);常规凝血参数凝血酶原时间(prothrombin time, PT)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、国际标准化比值(international normalized ratio, INR)、血浆纤维蛋白原(plasma fibrinogen, FIB)在治疗后均有所改善,差异具有统计学意义(均P＜0.01)。相关性分析显示,TEG参数中R值与PT、APTT及INR呈显著正相关,而K值则与PLT和FIB呈显著负相关(P＜0.05)。相较于单一TEG参数,联合检测在预后预测中的AUC更高(P＜0.01),灵敏度为75.85%,特异度为92.17%。结论:TEG检测在反映DPMAS联合PE治疗ACLF患者的动态凝血状态优于常规凝血指标,且对ACLF患者预后具有较高的预测价值。
Objective: Assessment of thromboela-stography (TEG) as a monitoring approach for coagulation changes and as a predictor of treatment efficacy in the management of slowly progressive ACLF with DPMAS combined with PE. Methods: A total of forty-nine patients with slowly progressive acute liver failure treated with DPMAS combined with PE in the General Hospital of Ningxia Medical University were collected. TEG and routine coagulation parameters were assessed before and after treatment, and relevant clinical data and coagulation indices,including prothrombin time(PT)、activated partial thromboplastin time(APTT)、international normalized ratio(INR)、plasma fibrinogen(FIB) were collected for statistical analysis. Pearson's method was applied to explore potential correlations between TEG-derived metrics and traditional coagulation indicators. In addition, ROC analysis was conducted to determine the capacity of TEG parameters, both alone and in combination, to predict clinical outcomes in ACLF patients. Results: Compared with pre-treatment levels, patients treated with DPMAS combined with PE showed significant improvements in clinical characteristics and laboratory indicators (P＜0.05) . TEG test results showed a significant decrease in R-value and a significant increase in coagulation index (P=0.001); conventional coagulation tests PT, APTT, INR, and FIB indexes improved significantly, with statistical significance (all P＜0.01). R was found to be positively linked to PT, APTT, and INR, while K showed a negative correlation with PLT and FIB, with all relationships reaching statistical significance (P＜0.05). The AUC of TEG parameters for predicting patient prognosis was significantly higher than that of single-item evaluation(P＜0.01), with a sensitivity of 75.85% and a specificity of 92.17%. Conclusion: In patients with ACLF receiving DPMAS combined with PE, dynamic coagulation profiles assessed by TEG were more reflective of clinical status than conventional indicators and exhibited superior predictive capability regarding outcomes.
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