血栓弹力图参数对缺血性卒中患者静脉溶栓后早期神经功能恶化的预测价值  

Predictive value of thromboelastographic parameters for early neurological deterioration after intravenous thrombolysis in patients with ischemic stroke

作　　者：尹克金 孙鸿 王学军 孙坚 吴成放 王文斌 栾丽芹 Yin Kejin;Sun Hong;Wang Xuejun;Sun Jian;Wu Chengfang;Wang Wenbin;Luan Liqin(Department of Neurology,the Affiliated Nanjing Jiangbei People's Hospital,Nantong University,Nanjing 210000,China)

机构地区：[1]南通大学附属南京江北人民医院神经内科,南京210000

出　　处：《国际脑血管病杂志》2020年第8期600-604,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨血栓弹力图(thrombelastography, TEG)参数对缺血性卒中患者静脉溶栓后早期神经功能恶化(early neurological deterioration, END)的预测价值。方法:连续纳入2017年1月至2019年12月在南京江北人民医院接受静脉溶栓治疗的急性缺血性卒中患者。入院24 h内完成TEG检查。END定义为入院24 h内任意一次美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分较基线增加≥4分。采用单变量分析比较END组和非END组之间人口统计学特征、基线资料、实验室指标以及TEG参数的差异。采用多变量 logistic回归分析确定END的独立危险因素。采用受试者工作特征(receiver operating characteristics, ROC)曲线评估不同模型对END的预测价值。 结果:共纳入174例急性缺血性卒中患者,年龄(68.9±13.4)岁,男性111例(63.8%),中位基线NIHSS评分为5.0分,29例(16.7%)发生END。与非END组患者相比,END组患者年龄、高半胱氨酸、空腹血糖、高敏C反应蛋白、基线NIHSS评分以及存在糖尿病和出血性转化的患者比例均显著增高( P均<0.05),而TEG凝血反应时间显著缩短( P=0.005)。多变量 logistic回归分析显示,在校正混杂因素后,年龄[优势比(odds ratio, OR)1.023,95%可信区间(confidence interval, CI)1.002 -1.066;P=0.031]、糖尿病( OR 2.627,95% CI 1.021-7.176;P=0.041)、高敏C反应蛋白较高( OR 1.050,95% CI 1.018-1.083;P=0.002)、出血性转化( OR 3.088,95% CI 1.707 - 13.492;P=0.034)及TEG凝血反应时间缩短( OR 0.440,95% CI 0.213-0.907;P=0.026)是接受静脉溶栓治疗的急性缺血性卒中患者END的独立危险因素。ROC分析显示,由年龄、糖尿病、超敏C反应蛋白水平及出血性转化构成的基础模型预测END的曲线下面积为0.766(95% CI 0.665-0.871)。将TEG凝血反应时间加入基础模型后,预测END的ROC曲线下面积增至0.816(95% CI 0.733-0.899)。 结论:TEG凝血反应时间缩短对接受静脉溶栓治疗的急性缺�Objective To investigate the predictive value of thromboelastographic(TEG)parameters for early neurological deterioration(END)after intravenous thrombolysis in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in Nanjing Jiangbei People's Hospital between January 2017 and December 2019 were enrolled.They completed TEG examination within 24 h after admission.END was defined as an increase of 4 points or more from the baseline National Institutes of Health Stroke Scale(NIHSS)score within 24 h after admission.Univariate analysis was used to compare the demographic characteristics,baseline data,laboratory indicators and TEG parameters between the END group and the non-END group.Multivariate logistic regression analysis was used to determine the independent risk factors for END.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of different models for END.Results A total of 174 patients with acute ischemic stroke were enrolled,aged(68.9±13.4)years,111(63.8%)were male,median baseline NIHSS score was 5.0,and 29(16.7%)had END.Compared with the patients in the non-END group,the age,homocysteine,fasting blood glucose,high-sensitivity C-reactive protein(hs-CRP),baseline NIHSS score and the proportion of patients with diabetes mellitus and hemorrhagic transformation(HT)in the END group were significantly increased(all P<0.05),and the coagulation reaction time of TEG was significantly reduced(P=0.005).Multivariate logistic regression analysis showed that after adjusting for confounding factors,age(odds ratio[OR]1.023,95%confidence interval[CI]1.002-1.066;P=0.031),diabetes mellitus(OR 2.627,95%CI 1.021-7.176;P=0.041),higher hs-CRP level(OR 1.050,95%CI 1.018-1.083;P=0.002),HT(OR 3.088,95%CI 1.707-13.492;P=0.034)and TEG coagulation reaction time reduction(OR 0.440,95%CI 0.213-0.907;P=0.026)were the independent risk factors for END in patients with acute ischemic stroke receiving intravenous thrombolysis.ROC analysi

关 键 词：卒中 脑缺血 血栓溶解疗法 血栓弹力描记术 疾病恶化 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]