脑梗死与脑出血患者的血栓弹力图结果比较及其临床意义  

Comparison and clinical significance of thrombelastogram in patients with cerebral infarction or cerebral hemorrhage

作　　者：李春凤[1] 李静[1] 赵学英 朱玉芳 亓颖芝 邱霞 张敏[1] 周中民 郎晓艳 芦鑫[1] LI Chunfeng;LI Jing;ZHAO Xueying;ZHU Yufang;QI Yingzhi;QIU Xia;ZHANG Min;ZHOU Zhongmin;LANG Xiaoyan;LU Xin(Department of Blood Transfusion,The Second Hospital of Shandong University,Jinan 250033,Shandong,China)

机构地区：[1]山东大学第二医院输血科

出　　处：《山东大学学报（医学版）》2019年第12期80-85,共6页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2017PH059)

摘　　要：目的探讨脑梗死与脑出血患者血栓弹力图检测指标的变化以及与传统凝血功能检测结果的相关性。方法选择2018年3月至2019年3月山东大学第二医院收治的73例脑梗死病例和46例脑出血病例作为研究对象,同期在我院体检的健康人群20例作为健康对照组,检测血栓弹力图(TEG)的5项主要指标:凝血反应时间(R值)、凝血形成时间(K值)、血凝块形成速率或α角(Angle)、血栓最大幅度(MA)、凝血综合指数(CI)和传统凝血功能指标:凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原浓度(FIB)、D二聚体(D-Dimer)以及血小板数量(PLT)。结果3组的K值、Angle、MA值、CI的结果差异有统计学意义,R值无明显差异;脑出血组的Angle、MA值、CI均低于健康对照组,而脑梗死组患者的Angle、MA值、CI均高于健康对照组,脑出血组的K值高于脑梗死组(P<0.05);脑出血组的PLT低于脑梗死组(P<0.05);凝血功能检测结果显示,脑出血组的APTT低于脑梗死组,PT、D-Dimer高于脑梗死组,差异均具有统计学意义,而两组的FIB、TT无明显差异;血栓弹力图的R值与APTT,K值与PT,Angle、MA和CI与FIB、PLT均呈正相关;而K与FIB、PLT,MA与PT、TT,CI与PT、APTT均呈负相关(P<0.05)。结论脑梗死与脑出血在急性发病期凝血状态复杂,传统凝血功能检测存在片面性和不及时性,而采用血栓弹力图可以更加直观、准确地反映患者真实的凝血状态,以指导临床提高诊治效率。Objective To investigate the changes of thromboelastogram(TEG)indicators in patients with cerebral infarction and cerebral hemorrhage,and the correlation with the results of traditional coagulation tests.Methods A total of 73 cases of cerebral infarction and 46 cases of cerebral hemorrhage admitted during March 2018 and March 2019 were selected as the research subjects,and 20 healthy people who received physical examination in our hospital during the same period served as healthy controls.The main indicators of TEG and traditional coagulation function indicators were detected,including coagulation reaction time(R value),coagulation formation time(K value),blood clot formation rate orαangle(Angle),maximum thrombus amplitude(MA),coagulation index(CI),prothrombin time(PT),activated partial prothrombin time(APTT),thrombin time(TT),fibrinogen concentration(FIB),D-Dimer,and platelet counts.Results There were significant differences in the values of K,Angle,MA and CI among the 3 groups(P<0.05)while no significant difference in the R value.The Angle,MA and CI values of the hemorrhage group were lowerthan those of control group,and the Angle,MA and CI value of the infarction group were higher than those of the controls.The K value of hemorrhage group was higher than that of infarction group,while the platelet count(PLT)was lower(both P<0.05).The APTT in the hemorrhage group was lower than that in the infarction group,while PT and D-Dimer were higher(all P<0.05).There were no significant differences in FIB and TT between the two groups.There were positive correlations between R and APTT,between K,PT and Angle,between MA,CI,FIB and PLT,while there were negative correlation between K and FIB,between PLT,MA and PT,between TT,CI,PT and APTT(all P<0.05).Conclusion Cerebral infarction and cerebral hemorrhage are complicated in the acute onset stage.The traditional coagulation function test is one-sided and untimely.TEG can reflect the true coagulation status more intuitively and accurately,so as to improve the diagnosis and tre

关 键 词：脑梗死 脑出血 凝血功能 血栓弹力图 输血治疗 

分 类 号：R446.1[医药卫生—诊断学]