RESUMO
Objective To explore the clinical significance of thromboelastography (TEG) in detecting coagulation status in elderly hypertensive patients.Methods A total of 75elderly patients with hypertension, were selected as the elderly hypertensive group.Meanwhile, 60cases of senile cerebral infarction patients and 47cases of normal elderly were selected as the senile cerebral infarction group and the normal elderly group respectively.The values of R, MA, α-Angle, K, CI were measured by TEG-5000thrombus elastometer and then compared in the three groups.Meanwhile, the values of platelet inhibition induced by AA and ADP were also detected in the elderly hypertensive group.The PLT and WBC of the elderly hypertensive group were detected by automatic five class blood cell analyzer.The correlation between TEG parameters and PLT and WBC in elderly hypertensive group were analyzed.Results Compared with the normal elderly group, the MA and CI of the elderly hypertensive group were significantly increased (P＜0.05), theα-Angle and K were significantly decreased (P＜0.05), the R value was not significantly different (P＞0.05), while in the senile cerebral infarction group, the R was significantly shortened (P＜0.05), the CI was significantly increased (P＜0.05) and the K value was significantly decreased (P＜0.05).Compared with the elderly hypertensive group, the R value of the aged cerebral infarction group was shortened (P＜0.05).In the elderly hypertensive group, PLT were negatively correlated with MA, α-Angle and CI, negatively correlated with K value, and not related to R value.WBC was positively correlated with MA, α-Angle and CI, negatively correlated with K value, and low correlation with R value.The proportion of patients ADP inhibition rate≥30％was 41.94％ (13/31), while the proportion of patients AA inhibition rate≥50％was 20.00％ (8/40).Conclusion The detection of TEG is of great significance in helping the clinical diagnosis, treatment guidance and disease monitoring of elderly hypertension, and can prevent the occurrence of complications of hypertension in the elderly hypertensive patients.
RESUMO
Objective To investigate the variety and clinical value of the neutrophil volume and cytoplasm-nucleus complex in patients with bacterial infection, cardiovascular or cerebrovascular accident and major surgery operation. Methods 125 patients with bacterial infection, 64 patients with acute cardiovascular or cerebrovascular accident, 66 patients after major surgery operation and 69 normal subjects were selected in the study. Total WBC counts (WBC), percentage of neutrophils (NE), and the VCS parameters of neutrephils including the mean channels of cell volume ( NEV), conductivity ( NEC), light scatter(NES) and the SD of these parameters( NEVSD, NECSD, NESSD)were measured by automatic blood cell analyzing instrument. The sensitivity and specificity of the WBC, NE and the VCS parameters of neutrophils were analyzed with receive operating characteristic (ROC) curve. Results The levels of NEV, NES and NEVSD in acute bacterial infection group were 154.3 ± 15.2, 135.7 ± 9.9, 26.8 ± 4.2 respectively. The levels of NEV, NES and NEVSD in post major surgery operation group were 147.2±8.9, 141.5 ± 7.7, 23.0 ± 2. 8 respectively. The levels of NEV, NES and NEVSD in acute cardiovascular or cerebruvascular accident group were 144.9 ± 5. 2, 146.0 ±5.0, 19. 6±1.6 respectively. The levels of NEV, NES and NEVSD in healthy control group were 139.7±4.6, 145.0±3.8, 18.2±1.3 respectively. The differences of these parameters among these groups had statistical significance ( F = 17. 650, 38. 122, 54. 604,P<0. 05). And the changes of NEV, NES and NEVSD in bacterial infection group were most obvious among those three groups. The levels of NEV, NES and NEVSD were 146.5±9.5, 144.3 ± 9.4, 21.3 ± 3.3 respectively in stress diseases groups which included acute cardiovascular or cerebrovascular accident group and post major surgery operation group. The differences of these parameters between stress diseases group and acute bacterial infection group had statistical significance ( t = - 2.840, 7.533, - 8.999,P<0.01). The areas under the ROC curve of NEVSD, NEC, NES and NECSD were 0.893, 0. 845, 0. 833 and 0. 849 respectively. The sensitivity of 83. 3% and specificity of 82. 0% could be achieved by selecting the cut-off equal to or greater than 24. 0. Conclusions The variety of neutrophil volume, nuclear size and cytoplasmic granularity changed obviously in patients with acute bacterial infection and common stress diseases, and the variety in acute bacterial infection is more obvious than that in common stress diseases. The sensitivity and specificity of VCS parameters of neutrophils are higher than those of WBC or NE for predicting infection, and the NEVSD is the most predictable indicator of acute bacterial infection.