血栓弹力图联合NLR早期诊断急性脑梗死后出血性转化的临床价值  

Clinical value of thromboelastography combined with NLR in early diagnosis of hemorrhagic transformation after acute cerebral infarction

作　　者：张源 施德 ZHANG Yuan;SHI De(Department of Neurology,Chongming Hospital Affiliated to Skanghqi University of Medicine and Health Sciences,Shanghai 202150,China)

机构地区：[1]上海健康医学院附属崇明医院神经内科,上海202150

出　　处：《中国急救复苏与灾害医学杂志》2022年第11期1435-1438,1453,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市崇明区“可持续发展科技创新行动计划”项目(编号:CKY2020-17)。

摘　　要：目的研究血栓弹力图(TEG)联合中性粒细胞/淋巴细胞比值(NLR)早期诊断急性脑梗死后出血性转化(HT)的价值。方法选取2020年2月—2021年2月上海健康医学院附属崇明医院神经内科急性脑梗死患者119例,72 h后根据影像学检查判断是否出现HT分为HT组(n=24)与非HT组(n=95),均行血栓弹力图检查并检测NLR值。比较两组一般资料、TEG参数及NLR,采用Logistic回归分析分析HT发生的影响因素,采用ROC曲线分析TEG参数联合NLR对HT的诊断价值。结果两组性别、年龄、体质量指数(BMI)、并发症、吸烟史、饮酒史比较,差异无统计学意义(P>0.05);HT组出现症状至就诊时间、大面积脑梗死、大动脉粥样硬化、双重抗血小板治疗占比高于非HT组(P<0.05);两组凝固时间(K)、血栓最大振幅(MA)、凝血综合指数(CI)、血凝块强度(A)比较,差异无统计学意义(P>0.05);HT组凝血反应时间(R)、NLR大于非HT组,凝固角(α)小于非HT组(P<0.05);经Logistic回归分析,症状至就诊时间、大面积脑梗死、大动脉粥样硬化、双重抗血小板治疗、R、NLR为HT发生的危险因素,α为保护因素(P<0.05);经ROC分析显示,TEG参数R、α及NLR诊断HT的Cut-off值为6.84 min、67.35°、4.52,AUC值为0.707、0.731、0.945,联合诊断的AUC值为0.980。结论急性脑梗死后HT患者TEG参数与NLR明显异常变化,二者联合对HT的发生具有较高诊断价值。Objective To study the value of thromboelastography(TEG)combined with neutrophil/lymphocyte ratio(NLR)in the early diagnosis of hemorrhagic transformation(HT)after acute cerebral infarction.Methods From February 2020 to February 2021,one hundred and nineteen patients with acute cerebral infarction in the Department of Neurology,Chongming Hospital Affiliated to Shang hqi University of medicine and Health Sciences were selected.72 hours later,according to the imaging examination,they were divided into HT group(n=24)and non HT group(n=95).All patients underwent thromboelastography and NLR values were measured.The general data,TEG parameters and NLR of the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of HT.ROC curve was used to analyze the diagnostic value of TEG parameters and NLR for HT.Results There were no significant differences in gender,age,BMI,complications,smoking history,and drinking history between these two groups(all P>0.05).The time from onset to hospital visit of the HT group was significantly longer than that of the non-HT group(P<0.05).The percentages of large-area cerebral infarction,large atherosclerosis,and dual antiplatelet therapy of the HT group were all significantly higher than those of non-HT group(all P<0.05).There was no significant difference in coagulation time(K),maximum thrombus amplitude(MA),coagulation comprehensive index(CI)and blood clot strength(A)between the two groups(P>0.05).The blood coagulation time(R)and NLR of the HT group were both significantly higher than those of the non-HT group(both P>0.05),and the Solidification angle(α)of the HT group was significantly smaller than that of the non-HT group(P<0.05).Logistic regression analysis showed that the time from onset to hospital visit,large-area cerebral infarction,large atherosclerosis,dual antiplatelet therapy,R value and NLR level were risk factors of HT,and α was a protective factor(all P<0.05).ROC analysis showed that the cut-off values to diagnose HT of the TEG para

关 键 词：急性脑梗死 出血性转化 血栓弹力图 中性粒细胞/淋巴细胞比值 诊断价值 

分 类 号：R743[医药卫生—神经病学与精神病学]