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目的以血栓弹力图(thrombelastography,TEG)监测多发性骨髓瘤骨病(myeloma bone disease,MBD)围手术期凝血状态,探讨其与临床分型、肿瘤分期及肝素应用相关性。方法将2013年8月至2015年3月,于我院接受手术治疗的21例MBD患者设定为研究组,同期在我院接受体检的22名健康成人设定为正常对照组。所有两组病例均于术前接受TEG及传统凝血试验检测1次,MBD组于术后第1、3、5、7天再行TEG检测各1次。结果 (1)两组间术前两种检测结果差异无统计学意义(P>0.05),K值的P=0.066,Angle角的P=0.265,MA的P=0.095,CI的P=0.315,PT的P=0.462,APTT的P=0.310,Fbg的P=0.051,TT的P=0.821,PLT的P=0.071;(2)在MBD患者围手术期出凝血状态的动态改变中,TEG检测结果差异也无明显统计学意义(P>0.05),R值的P=0.361,K值的P=0.675,Angle角的P=0.487,MA的P=0.279,EPL的P=0.398,CI的P=0.775,LY30的P=0.398;(3)MBD患者使用肝素前后TEG检测差异均无统计学意义(P>0.05),R值的P=0.518,K值的P=0.831,Angle角的P=0.676,MA的P=0.304,EPL的P=0.307,CI的P=0.971,LY30的P=0.307;(4)不同MBD分型两种检测差异均无统计学意义(P>0.05),R值的P=0.342,K值的P=0.531,Angle角的P=0.574,MA的P=0.856,EPL的P=0.737,CI的P=0.505,LY30的P=0.747,PT的P=0.393,APTT的P=0.790,Fbg的P=0.966,TT的P=0.115,PLT的P=0.460;(5)不同MBD分期两种检测差异均无统计学意义(P>0.05),R值的P=0.293,K值的P=0.198,Angle角的P=0.178,MA的P=0.515,EPL的P=0.748,CI的P=0.125,LY30的P=0.748,PT的P=0.464,APTT的P=0.649,Fbg的P=0.649,TT的P=0.646,PLT的P=0.515。结论 MBD凝血状态复杂,应用TEG可以更加全面而准确地评估,MBD围手术期管理仍存在很多问题尚未解决。
Objective To monitor the perioperative coagulation status of multiple myeloma bone disease (MBD) by thrombelastography (TEG), and to explore its correlation with clinical classification, tumor staging and heparin application. Methods From August 2013 to March 2015, 21 patients with MBD who underwent surgery in our hospital were designated as the study group. The 22 healthy adults who were examined in our hospital during the same period were set as the normal control group. All the two groups of patients were tested by preoperative TEG and traditional coagulation tests. The MBD group was tested again by TEG on the first, third, fifth, and seventh days after operation. Results (1) There was no significant difference in the two preoperative results between the two groups (P>0.05). The K value was P=0.066, the Angle angle was P=0.265, MA was P=0.095, CI was P=0.315. P = 0.462 for PT, P = 0.310 for APTT, P = 0.051 for Fbg, P = 0.821 for TT, P = 0.071 for PLT; (2) TEG test results in the dynamic changes of coagulation status in MBD patients during perioperative period The difference was also not statistically significant (P>0.05). The R value was P=0.361, the K value was P=0.675, the Angle angle was P=0.487, MA was P=0.279, EPL was P=0.398, and CI was P= 0.775, LY30 P=0.398; (3) There was no significant difference in TEG detection between before and after use of heparin in patients with MBD (P>0.05). P value of R=0.518, K value of P=0.831, and Angle angle P=0.676 P=0.304 for MA, P=0.307 for EPL, P=0.971 for CI, and P=0.307 for LY30; (4) There were no significant differences between the two types of MBD tests (P>0.05). P=0.342, K value P=0.531, Angle angle P=0.574, MA P=0.856, EPL P=0.737, CI P=0.505, LY30 P=0.747, PT P=0.393, APTT P=0.790, Fbg P=0.966, TT P=0.115, PLT P=0.460; (5) There was no significant difference in the detection of different MBD staging (P>0.05), R value was P=0.293, K value of P=0.198, Angle of P=0.178, MA of P=0.515, EPL of P=0.748, CI of P=0.125, LY30 P=0.748, PT P=0.464, APTT P=0.649, Fbg P=0.649, TT P=0.646, PLT P=0.515. Conclusion The blood coagulation status of MBD is complex, and the application of TEG can be more comprehensive and accurate. There are still many problems in the management of MBD during perioperative period.