Zhongguo shuxue zazhi (Jun 2024)
Thromboelastography combined with conventional coagulation indices in the detection of endogenous heparin in patients with epidemic hemorrhagic fever
Abstract
Objective To detect endogenous heparin substance in patients with epidemic haemorrhagic fever (EHF) using thromboelastography (TEG) combined with conventional coagulation indices(CCTs), explore the value of TEG combined with CCTs in detecting coagulation function abnormalities in such patients, aiming at providing guidance for clinical treatment. Methods APTT, TT, TEG plain cup R value and TEG heparinase cup R value were tested in 35 EHF patients of mild/moderate stage, severe stage and recovery stage. Intergroup differences were analysed using Friedman ANOVA. Results The mean R and heparin cup R values were 7.5 and 6.7 for mild cases of EHF, and TT, R and heparinase cup R values were 16.9, 6.2 and 6.1 for recovering cases, respectively.The normal cup R and heparinase cup R values for mild cases, as well as the TT, R and heparinase cup R values for recovering cases, were normally distributed, and the rest were non-normally distributed. Changes in APTT and TT in EHF patients at different stages were significantly different (P<0.05). The patients′ TEG R-values (coagulation reaction time) also showed statistically significant differences in mild-moderate, severe and recovery periods (P<0.05). Prolonged APTT, TT and R values in the severe phase compared to the mild-moderate phase indicated that the patient′s coagulation function continued to decrease. The difference of R-values minus the heparanase cup R-values in EHF patients was statistically significant in the mild-moderate, severe, and recovery phases (P<0.05). Residual accumulation of endogenous heparin-like substances was higher in the severe phase than in the mild-moderate and recovery phases. Conclusion Patients with EHF exhibit significant differences in the values of APTT, TT and R at different stages of the disease. The combined detection using TEG and CCTs indicates that the accumulation of endogenous heparin-like substances is one of the most important causes of coagulation disorders in patients with EHF. The combination of TEG and CCTs can detect the accumulation of endogenous heparin-like substances in patients with EHF, which can provide a laboratory basis for clinicians to adopt targeted therapeutic regimen.
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