| Objective:Thromboembolic events(TEs)are one of the extra-intestinal manifestations of ulcerative colitis(UC),which seriously endangers the life safety of patients and has received more and more attention in recent years.TEs are associated with hypercoagulable state in peripheral blood of UC patients,the purpose of this study was to investigate the incidence of thrombotic events in UC patients,and to compare the clinical value of conventional coagulation tests and new technique TEG for the detection of hypercoagulable state in UC patients and analysis of risk factors for hypercoagulability in blood,to increase the vigilance of thrombotic events in UC patients,and provide more clinical evidence for the detection of hypercoagulable state,prevention of thrombosis and preventive anticoagulant therapy in UC patients.Methods:??Investigation and analysis of thrombosis in UC patients:The patients who were diagnosed as UC at the First Affiliated Hospital of Kunming Medical University from January 1,2011 to December 31,2015 were investigated.To collect demographic information,and the information on thrombophilia screening,prevention,and thromboembolic events during the visit.??Assessment of Blood Hypercoagulation State in UC patients:To select UC patients from January 1,2016 to January 31,2018 to the First Affiliated Hospital of Kunming Medical University for pediatric gastroenterology and outpatient visits as the experimental group,and healthy volunteers For the control group,the ratio is 5:1.Routine clotting function and thromboelastogram(TEG)are tested in the test and control groups.Conventional coagulation functions includ prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),and fibrinogen(FBG),D-dimer(D-Di),fibrinogen degradation product(FDP),antithrombin-?(AT-?),platelet(PLT);TEG includes clotting factor response time(R),FBG Response time(K),coagulation index(CI),solidification angle(Angle angle),maximum amplitude(MA).Any experimenter whose detection result is a hypercoagulable state needs to be improved by vascular ultrasound and enhanced CT examination of the chest and abdomen.The experimental groups need to improve the electronic colonoscopy and pathological examination of intestinal mucosal lesions.The microscopic thrombus formation of the intestinal mucosa of the diseased lesions is found as the gold standard for judging the state of hypercoagulability of blood.At the same time,the ESR,CRP,and PCT are needed to be improved in the test and control groups.To evaluate the clinical value of routine blood coagulation test and TEG detection of blood hypercoagulability in UC patients and logistic regression analysis of risk factors for blood hypercoagulability.Results:??UC patients with thrombosis survey analysis:1?This study included 402 patients with UC,29.83%of patients underwent thrombosis-related examinations,including D-Di,vascular ultrasound and vascular CT imaging,2.49%of patients received thromboprophylaxis-related preventive treatment.2?A total of 8 patients were found to have thrombosis.,one patient had multiple thrombosis,there were 9 thromboembolic events in total,including 8 with VTE,6 with DVT,2 with PE,and 1 with arterial thrombosis.DVT is the most common,accounting for 66.66%,followed by PE 22.22%.DVT is the most common,accounting for 66.66%,followed by PE 22.22%.The incidence of thrombotic events was 44.77/10,000 person-years,the incidence of VTE was 39.80/10,000 person-years,the incidence of DVT was 29.85/10,000 person-years,the incidence of PE was 9.95/10,000 person-years,and the incidence of arterial thrombosis was 4.98/10,000 person-years.??Assessment of Blood Hypercoagulation State in UC Patients:1?This trial group was included in the group of 102 cases,including 60 males,42 females,20 patients in the control group,11 males and 9 females.2?Compared with the control group's conventional coagulation function test and TEG test,the blood coagulation function of the test group was significantly abnormal,R and K values were significantly lower than the control group(p<0.01),and Angle,MA,and CI were significantly higher than the control group(p<0.01).PT and APTT were prolonged compared with the control group(p<0.05).FBG,D-Di,FDP,PLT were significantly higher than the control group(p<0.01).AT-? was lower than the control group(p<0.05).3?There were 50 patients in the test group with normal coagulation function and blood hypercoagulability state,28 cases in the test group with TEG blood hypercoagulability state,and 30 cases in the test group with blood hypercoagulability state in accordance with the gold standard.No blood hypercoagulability was found in either method.Patients in either of the two test methods who detected blood hypercoagulability didn't have thrombosis in the vascular ultrasound and thoracoabdominal CT.4?The sensitivity of blood coagulation test in conventional test group was 80%,specificity was 63.89%,positive predictive value was 48%,negative predictive value was 88.46%,accuracy rate was 68.63%,and missed diagnosis rate was 20%.The sensitivity of TEG in detecting the hypercoagulable state of UC patients was 76.67%,the specificity is 93.06%,the positive predictive value was 82.14%,the negative predictive value was 90.54%,the accuracy rate was 88.24%,and the missed diagnosis rate was 23.33%.5?Two-classified logistic regression analysis found that the extent of disease,disease severity,diabetes,glucocorticoid,history of colon surgery,history of thrombosis,and smoking were all risk factors for hypercoagulability in UC patients(p<0.05,OR>1).Conclusions:1?The incidence of thrombotic events in UC patients in our hospital was 44.77/10,000 person-years,DVT was the most common,followed by PE,no less than always reported incidence of thrombotic events at home and abroad,the prevalence of thromboembolic screening and preventive treatment was relatively low,thromboembolic screening and prophylactic antithrombotic therapy should be strengthened in patients with UC.2?The coagulation function of UC patients was obviously different from normal people,and it was in hypercoagulable state.The specificity,positive predictive value and accuracy of TEG in detecting blood hypercoagulability in patients with UC were significantly higher than those in routine coagulation tests,but the sensitivity,negative predictive value,and missed diagnosis rate were not significantly different between the two groups.ETG can be used as a reliable clinical test to detect hypercoagulation in UC patients.3?The degree of disease,extent of disease,diabetes,glucocorticoid,history of colon surgery,history of thrombosis,and smoking were risk factors for hypercoagulability in UC patients(p<0.05,OR>1),the more extensive the lesions and the more severe the degree of disease in UC patients,the greater the possibility of blood hypercoagulability. |
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