缺血性脑卒中治疗前后血栓弹力图参数变化与病情程度、复发缺血相关性分析  

Correlation of the Changes of Thromboelastography Parameters before and after Treatment of Ischemic Stroke with Severity of Disease and Recurrence of Ischemia

作　　者：贺扬欣 张萌[2] 梁珊珊 许亚莉[1] 万春晶 王宝燕[1] HE Yang-xin;ZHANG Meng;LIANG Shan-shan;XU Ya-li;WAN Chun-jing;WANG Bao-yan(Department of Blood Transfusion,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学医学院第一附属医院输血科,西安710061 [2]西安交通大学医学院第一附属医院神经内科,西安710061

出　　处：《临床误诊误治》2022年第10期100-105,共6页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省自然科学基础研究计划(2020JQ-529)。

摘　　要：目的探究急性缺血性脑卒中(AIS)治疗前后血栓弹力图(TEG)参数变化与病情程度、复发缺血相关性。方法回顾性分析2020年1月-2022年1月收治的AIS 235例的临床资料,统计出院后6个月内复发缺血情况,根据是否复发缺血分为复发组和未复发组,比较2组一般资料、治疗前后TEG参数,并比较不同病情程度患者治疗前TEG参数[血细胞凝集块形成时间(K值)、凝血反应时间(R值)、最大血块强度(MA值)、血凝块形成速率(α角)],采用Spearman相关分析治疗前TEG参数与AIS病情程度的相关性,通过受试者工作特征(ROC)曲线评价治疗后TEG参数预测复发缺血的价值。结果本研究235例AIS患者出院后6个月内复发缺血25例(10.64%)。复发组治疗后K值、R值低于未复发组,MA值、α角高于未复发组(P<0.05,P<0.01)。K值、R值重度患者<中度患者<轻度患者,MA值、α角重度患者>中度患者>轻度患者(P<0.05)。治疗前K值、R值与AIS病情程度呈负相关(r=-0.715、-0.748,P<0.01),MA值、α角与AIS病情程度呈正相关(r=0.727、0.768,P<0.01)。治疗后K值、R值、MA值、α角预测AIS复发缺血的曲线下面积(AUC)均>0.7,联合预测AUC最大,为0.954。结论AIS患者治疗前TEG参数与病情程度密切相关,治疗后TEG参数在预测复发缺血方面具有一定价值,治疗前后检测TEG参数变化有助于评估AIS病情和预测复发缺血。Objective To explore the correlation of the changes of thromboelastography(TEG)parameters before and after treatment of acute ischemic stroke(AIS)with the severity of disease and recurrence of ischemia.Methods Clinical data of 235 patients with AIS treated from January 2020 to January 2022 were retrospectively analyzed.The recurrence of ischemia within 6 months after discharge was documented,and those patients were divided into recurrence group and non-recurrence groups according to presence of recurrence of ischemia.The general data,TEG parameters before and after treatment,and the TEG parameters[clot formation time(K value),clot reaction time(R value),maximum clot strength(MA value),and clot formation rate(αangle)]in patients with different severities of disease were compared between the two groups.The correlation between TEG parameters before treatment and the severities of AIS disease was analyzed using Spearman's correlation analysis,and the value of TEG parameters before treatment in predicting the recurrence of ischemia was evaluated by receiver operating characteristic(ROC)curve.Results In this study,25 cases(10.64%)of 235 AIS patients had recurrence of ischemia within 6 months after discharge.After treatment,the K value and R value of the recurrence group were lower than those of the non-recurrence group,while the MA value andαangle were higher than those of the non-recurrence group(P<0.05,P<0.01).Severe patients had the lowest K value and R value,followed by moderate patients and mild patients,while severe patients had the highest MA value andαangle,followed by moderate patients and mild patients(P<0.05).Before treatment,K value and R value were negatively correlated with the severity of AIS(r=-0.715,-0.748,P<0.01),while MA value andαangle were positively correlated with the severity of AIS(r=0.727,0.768,P<0.01).After treatment,the area under the ROC curve(AUC)of K value,R value,MA value andαangle for predicting recurrence of ischemia in AIS patients was>0.7,and the AUC of combined detection was th

关 键 词：急性缺血性脑卒中 血栓弹力图 血细胞凝集块形成时间 凝血反应时间 最大血块强度 血凝块形成速率 复发 

分 类 号：R743[医药卫生—神经病学与精神病学]