血栓弹力图参数预测急性缺血性卒中患者早期神经功能恶化  

Thromboelastography parameters predict early neurological deterioration in patients with acute ischemic stroke

作　　者：沈小平 王士列 刘建平 李年春 Shen Xiaoping;Wang Shilie;Liu Jianping;Li Nianchun(Jiujiang Hospital Affiliated to Nanchang University,Jiujiang 332000,China)

机构地区：[1]南昌大学附属九江医院,九江332000

出　　处：《国际脑血管病杂志》2019年第12期891-895,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨血栓弹力图(thrombelastography,TEG)对急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的预测价值。方法纳入2018年1月至2019年5月在南昌大学附属九江医院神经内科住院的急性缺血性卒中患者作为病例组,选取同期门诊健康体检者作为对照组。END定义为急性缺血性卒中患者在发病7 d内美国国立卫生研究院卒中量表评分较基线增加≥2分。所有受试者常规行传统凝血功能检查,包括凝血酶原时间、活化部分凝血活酶时间、凝血酶时间以及血浆纤维蛋白原水平,并利用TEG监测反应时间(R值)、凝固时间(K值)、凝固角(α)和最大振幅(MA值)。利用单变量分析比较END组与非END组各项临床和实验室检查结果的差异,然后应用多变量logistic回归分析确定END的独立危险因素。结果共纳入96例急性缺血性卒中患者和20例对照者。对于各项传统凝血指标,病例组与对照组相比均无显著统计学差异;对于TEG参数,与对照组相比,病例组R值及K值显著缩短,α角和MA值显著升高(P均<0.05)。总共31例患者(32.3%)发生END,END组R值和K值较非END组显著缩短(P均<0.05)。多变量logistic回归分析显示,R值(优势比1.192,95%可信区间1.006~1.410;P=0.001)和K值(优势比1.054,95%可信区间1.012~1.150;P=0.001)缩短为END的独立预测因素。结论TEG应用于急性缺血性卒中患者凝血功能监测的敏感性高于传统凝血指标,其中R值及K值缩短为急性缺血性卒中患者发生END的独立预测因素。Objective To investigate the predictive value of thromboelastography(TEG)for early neurological deterioration(END)in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,Jiujiang Hospital Affiliated to Nanchang University from January 2018 to May 2019 were included as case group,and the healthy physical examinees in the same period were selected as control group.END was defined as an increase of≥2 of the National Institutes of Health Stroke Scale score from baseline within 7 d after the onset of acute ischemic stroke.All subjects were routinely tested for traditional coagulation function,including prothrombin time,activated partial thromboplastin time,thrombin time,and plasma fibrinogen level.The reaction time(R value),coagulation time(K value),coagulation angle(α)and maximum amplitude(MA value)were monitored by TEG.Univariate analysis was used to compare the differences in clinical and laboratory results between the END group and the non-END group,and then multivariate logistic regression analysis was used to determine the independent risk factors for END.Results A total of 96 patients with acute ischemic stroke and 20 controls were included.Compared with the control group,the traditional coagulation parameters of the case group were not significantly different.For the TEG parameter,compared with the control group,the R value and K value of the case group were significantly shortened,and theαangle and MA value were significantly increased(all P<0.05).A total of 31 patients(32.3%)developed END,and the R and K values in the END group were significantly shorter than those in the non-END group(all P<0.05).Multivariate logistic regression analysis showed that R value(odds ratio 1.192,95%confidence interval 1.006-1.410;P=0.001)and K value(odds ratio 1.054,95%confidence interval 1.012-1.150;P=0.001)shortening were the independent predictors of END.Conclusion The sensitivity of TEG in the monitoring of coagulation function in patients with acute isch

关 键 词：卒中 脑缺血 血栓弹力描记术 疾病恶化 时间因素 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]