凝血功能及血栓弹力图在急性缺血性脑卒中静脉溶栓预后中的预警作用  

The predictive effect of coagulation function and thromboelastography on the prognosis of acute thrombolysis in acute ischemic stroke

作　　者：洪二春 戴李华[1] 王海嵘[1] 陈淼[1] HONG Er-chun;DAI Li-hua;WANG Hai-rong;CHEN Miao(Department of Emergency Medicine,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院急诊科,上海200092

出　　处：《东南国防医药》2018年第5期485-489,共5页Military Medical Journal of Southeast China

摘　　要：目的探讨凝血功能相关指标对急性缺血性卒中(AIS)患者静脉溶栓预后的预测作用。方法回顾性分析2010年1月至2017年8月所有在上海交通大学医学院附属新华医院接受静脉溶栓治疗的AIS患者的临床资料及凝血功能相关指标,按照1年后改良的Rankin评分(mRS)分为预后良好组(mRS≤1)及预后不良组(mRS>1),Logistic回归对预后相关独立危险因素进行分析。结果共纳入362例患者,其中静脉溶栓后预后良好组278例,预后不良组84例。多因素Logistic回归分析显示,入院NIHSS评分(OR=1.009,95%CI:1.040~1.162)、纤维蛋白降解产物(FDP)(OR=1.013,95%CI:1.001~1.026)及血栓弹力图-MA(TEG-MA)(OR=1.020,95%CI:1.006~1.035)增高和高龄(OR=1.045,95%CI:1.015~1.076)是AIS患者静脉溶栓后12个月预后不良的独立危险因素(均P<0. 05)。对独立危险因素FDP及TEG-MA进行ROC曲线分析,显示曲线下面积分别为0. 619(95%CI:0. 548~0. 691; P=0. 037)、0. 615(95%CI:0. 546~0. 685; P=0. 035)。约登指数分析结果显示,FDP的临界值为1.33 mg/L(敏感性63.2%,特异性59.5%)、TEG-MA的临界值为65.25 mm(敏感性56.8%,特异性67.1%)。结论 FDP和TEG-MA是AIS患者静脉溶栓预后的独立危险因素; FDP预测价值略高于TEG-MA; FDP和TEG-MA越高,预后越差。Objective To investigate the predictive effect of relative indicators in coagulation function on the prognosis of thrombolysis in patients with acute ischemic stroke （AIS）. Methods Retrospective analysis of clinical data and coagulation-related indexes of all patients with AIS who received intravenous thrombolysis in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2010 and August 2017. According to the modified rankin scale （mRS） at the 1-year follow-up after thrombolysis, patients were divided into well-proven groups （mRS≤1 point,） and poor-prognosis group （mRS〉1 point）. Logistic regression model was used to evaluate the relative dependent risk factors. Results 278 patients were enrolled in the good prognosis group while 84 patients in the poor prognosis group according to the modified Rankin scale. Multivariate logistic regression analysis showed that NIHSS score on admission （OR=1.009, 95%CI：1.040 to 1.162）, fibrinogen degeneration products （FDP）（OR=1.013, 95%CI：1.001 to 1.026 ）, Thromboelastography- MA （TEG-MA）（OR=1.020, 95%CI：1.006 to 1.035） and advanced age were independent risk factors for poor prognosis at 12 months after admission in patients with AIS （all P 〈0.05）. ROC curve analysis of independent risk factors FDP and TEG-MA showed that the area under the curve was 0.619（95%CI：0.548 to 0.691; P =0.037） and 0.615 （95%CI：0.546 to 0.685; P =0.035）,respectively. Futhermore,the results of the Yoden index analysis showed that the critical value of FDP was 1.33 mg/L （sensitivity 63.2%, specificity 59.5%） and the critical value of TEG-MA was 65.25 mm （sensitivity 56.8%, specificity 67.1%）. Conclusion Such risk factors as FDP and TEG-MA are warning indicators of acute ischemic stroke treated with thrombolytic therapy.The higher the numerical values of those two variables, the worse prognosis the patients suffered.FDP shows better warning value than that of TEG-MA.

关 键 词：急性缺血性脑卒中 静脉溶栓 预后 血栓弹力图 凝血功能 

分 类 号：R743.33[医药卫生—神经病学与精神病学]