血栓弹力图与急性冠脉综合征患者冠状动脉病变严重程度的相关性分析

doi:10.16150/j.1671-2870.2025.05.009

摘要/Abstract

摘要：

目的： 探讨血栓弹力图（thrombelastogram， TEG）与急性冠脉综合征（acute coronary syndrome， ACS）患者冠状动脉（冠脉）病变程度的相关性。方法： 连续收集130例我院心血管内科收治的接受冠脉造影检查且结果为阳性的患者，作为ACS组，纳入同期行冠脉造影排除ACS的患者86例，作为对照组。检测所有研究对象的TEG参数[凝血反应时间（reaction time，R time）、凝血形成时间（clotting time，K time）、血块生成速度（blood clot formation rate，Angle α， α角）、最大振幅（maximum amplitude， MA）]及甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、乳酸脱氢酶、血小板水平。比较ACS组与对照组TEG指标差异，筛选ACS潜在危险因素；在ACS患者中，分析TEG参数与实验室相关指标及冠状动脉病变程度Gensini积分的相关性；采用Logistic回归分析评估不同冠状动脉病变支数ACS患者TEG的影响因素，并在校正混杂因素后进一步评估TEG对患ACS风险的独立预测作用。结果： ACS组的TEG（R time和K time）低于对照组，差异有统计学意义（P<0.01）；TEG（R time、K time）与Gensini积分均呈负相关（r_{R time}=-0.302 3， r_{K time}=-0.257 4， P<0.01）。多因素Logistic回归分析，在调整了混杂因素后，当TEG（K time）被视为分类变量时，Q4 （K time >2.10）可作为ACS发病的独立保护因素（OR=0.34，95%CI为0.13~0.87， P<0.05）。受试者操作特征曲线分析显示，R time、K time诊断ACS的曲线下面积（area under the curve， AUC）分别为0.781 0、0.605 1，TEG参数R time诊断ACS的灵敏度为73.26%，特异度为70.00%，TEG参数K time诊断ACS的灵敏度为65.38%，特异度为60.47%。结论： TEG与ACS及冠脉病变严重程度相关，可能是ACS患者冠状动脉病变严重程度的独立预测因子，能为是否需要进一步行侵入性诊断提供有力依据。

关键词: 血栓弹力图, 急性冠脉综合征, 冠状动脉病变

Abstract:

Objective To investigate the correlation between thrombelastography (TEG) and the severity of coronary artery lesions in patients with acute coronary syndrome (ACS). Methods A total of 130 patients admitted to the Department of Cardiology of our hospital who underwent coronary angiography and had positive results were consecutively recruited as the ACS group. Meanwhile, 86 patients with ACS excluded by coronary angiography during the same period were selected as the control group. TEG parameters [reaction time (R time), clotting time (K time), blood clot formation rate (Angle α), maximum amplitude (MA)], triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, lactate dehydrogenase, and platelet levels were measured for all subjects. The differences in TEG indicators between the ACS group and control group were compared to identify potential risk factors for ACS. In ACS patients, the correlations of TEG parame-ters with laboratory-related indicators and the severity of coronary artery lesions assessed by the Gensini score were evalua-ted and analyzed. Logistic regression analysis was employed to evaluate the influencing factors of TEG in ACS patients with different numbers of coronary artery lesions. After adjusting for confounding factors, the independent predictive effect of TEG on the risk of ACS was further evaluated. Results The TEG parameters (R time and K time) in the ACS group were lower than those in the control group, and the difference was statistically significant (P<0.01). TEG parameters (R time and K time) were negatively correlated with the Gensini score (r_{R time}=-0.302 3, r_{K time}=-0.257 4, P<0.01). Multivariate logistic regression analysis showed that after adjusting for confounding factors, when TEG (K time) was considered as a categorical variable, Q4 (K time >2.10) was an independent protective factor against ACS (OR=0.34, 95% CI: 0.13-0.87, P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of R time and K time for diagnosing ACS was 0.781 0 and 0.605 1, respectively. The TEG parameter (R time) showed a sensitivity of 73.26% and a specificity of 70.00% for diagnosing ACS, while the K time showed a sensitivity of 65.38% and a specificity of 60.47%. Conclusion TEG is associated with ACS and the severity of coronary artery lesions and may serve as an independent predictor of the severity of coronary artery lesions in patients with ACS, which can provide a strong basis for determining whether further invasive diagnosis is needed.

Key words: Thrombelastography, Acute coronary syndrome, Coronary artery lesions

中图分类号:

徐申, 孙瑞状, 余沁, 刘渠凯, 丁宁. 血栓弹力图与急性冠脉综合征患者冠状动脉病变严重程度的相关性分析[J]. 诊断学理论与实践, 2025, 24(05): 534-541.

XU Shen, SUN Ruizhuang, YU Qin, LIU Qukai, DING Ning. Analysis of correlation between thrombelastography and severity of coronary artery lesions in patients with acute coronary syndrome[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(05): 534-541.

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参考文献 23

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Degree of stenosis	≤25%	26%-50%	51%-75%	76%-90%	91%-99%	100%
Score	1	2	4	8	16	32
Location of lesion	LAC	proximal segment of LAD or LCX	mid-segment of LAD	mid-to-distal segment of LCX and the distal segment of LAD	RCA	branches of the coronary arteries
Disease coefficient	5	2.5	1.5	1	1	0.5

Item		Control group	ACS group	t/χ²	P
No. of participants[n (%)]		86 (41.20%)	130 (58.80%)
Gender	Male[n (%)]	55 (63.95%)	95 (73.08%)	1.43	0.154
Gender	Female[n (%)]	31 (36.05%)	35 (26.92%)	1.43	0.154
Age (years), mean ± SD		63.44 ± 11.08	63.00 ± 10.98	0.29	0.773
Laboratory results（mean ± SD）
R time (min)		6.99 ± 1.29	5.63 ± 1.25	7.75	<0.01
K time (min)		1.91 ± 0.46	1.75 ± 0.45	2.66	<0.01
Angle α (°)		64.84 ± 5.40	64.09 ± 5.88	0.94	0.35
MA (mm)		62.84 ± 4.76	63.35 ± 5.25	0.72	0.47
PLT (×10⁹/L)		202.36 ± 61.70	200.65 ± 55.72	0.21	0.83
TG (mmol/L)		1.41 ± 0.87	2.09 ± 2.40	2.50	<0.05
TC (mmol/L)		3.79 ± 1.04	4.25 ± 1.25	2.83	<0.01
HDL-C (mmol/L)		1.14 ± 0.29	1.13 ± 0.92	0.10	0.92
LDL-C (mmol/L)		2.31 ± 0.72	2.50 ± 0.89	1.63	0.11
LDH (U/L)		183.85 ± 71.14	242.88 ± 54.75	3.29	<0.01

Item	OR	95%CI	P
TG	1.52	1.09-2.11	0.013
TC	1.42	1.11-1.83	<0.01
HDL-C	0.98	0.68-1.41	0.92
LDL-C	1.33	0.94-1.87	0.12
LDH	1.006	1.002-1.009	<0.01
PLT	0.999	0.995-1.004	0.83
R time	0.43	0.33-0.56	<0.001
K time	0.43	0.23-0.82	0.01
Angle α	0.98	0.93-1.03	0.35
MA	1.02	0.97-1.08	0.47

Index	No. of lesion vessels	OR	95%CI	P
R time	Single-vessel lesion	Reference
	Double-vessel lesion	0.70	0.50-0.80	0.04
	Multi-vessel lesion	0.59	0.39-0.89	0.01
K time	Single-vessel lesion	Reference
	Double-vessel lesion	0.30	0.11-0.83	0.02
	Multi-vessel lesion	0.33	0.11-0.99	0.04
Angle α	Single-vessel lesion	Reference
	Double-vessel lesion	1.03	0.96-1.10	0.41
	Multi-vessel lesion	1.03	0.96-1.12	0.45
MA	Single-vessel lesion	Reference
	Double-vessel lesion	1.01	0.93-1.09	0.79
	Multi-vessel lesion	1.05	0.96-1.14	0.30

Group	Number of cases	R time (min)	K time (min)	Angle α (°)	MA (mm)
Single-vessel lesion	48	6.02 ± 1.25	1.87 ± 0.49	63.46 ± 5.69	62.92 ± 4.85
Double-vessel lesion	45	5.44 ± 1.34	1.68 ± 0.36	64.49 ± 6.38	63.20 ± 5.58
Multi-vessel lesion	37	5.34 ± 1.02	1.65 ± 0.33	64.43 ± 5.57	64.09 ± 5.41
F		4.04	4.03	0.44	0.54
P		0.02	0.02	0.64	0.58