血栓弹力图联合PLR对伴脑小血管病的急性脑梗死后出血性转化风险的评估价值  

Value of thromboelastography combined with PLR in assessing the risk of hemorrhagic transformation after acute cerebral infarction with cerebrovascular disease

作　　者：应黎 张重生 赵博轩 李华 王文安 YING Li;ZHANG Chongsheng;ZHAO Boxuan;LI Hua;WANG Wenan(Department of Neurology,Chongming Branch,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 202150,China)

机构地区：[1]上海健康医学院附属崇明医院神经科,上海202150

出　　处：《中国急救复苏与灾害医学杂志》2023年第2期195-198,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海浦东新区卫健委临床高原学科建设项目(编号:PWYgy2021-11);上海市崇明区“可持续发展科技创新行动计划”项目(编号:CKY2022-22)。

摘　　要：目的研究血栓弹力图(TEG)联合血小板/淋巴细胞比值(PLR)对伴脑小血管病(CSVD)的急性脑梗死后出血性转化(HT)风险的评估价值。方法选取2019年1月—2021年12月上海健康医学院附属崇明医院伴CSVD的急性脑梗死患者97例,并按照入院7 d内是否发生HT分为HT组与非HT组,比较两组一般资料、TEG参数及PLR值,分析HT发生的影响因素,采用受试者工作特征(ROC)曲线评估TEG参数联合PLR对HT的预测价值。结果97例伴CSVD的急性脑梗死患者23例发生HT,HT发生率为23.71%;HT组与非HT组性别、年龄、BMI、基础疾病、发生症状至就诊时间、脑梗死部位、抗栓治疗比较,差异无统计学意义(P>0.05);HT组大面积梗死、CSVD脑白质高信号分度为重度、双重抗血小板占比高于非HT组(P<0.05);两组凝固时间(K)、血栓最大振幅(MA)、凝固角(α)比较,差异无统计学意义(P>0.05);HT组凝血反应时间(R)、血凝块稳定性(LY30)、血小板/淋巴细胞比值(PLR)大于非HT组(P<0.05);经Logistic回归分析,大面积脑梗死、CSVD脑白质高信号分度、双重抗血小板治疗、R、LY30、PLR为HT发生的危险因素(P<0.05);ROC曲线分析显示,TEG参数R、LY30及PLR诊断HT的Cut-off值为6.00 min、2.352%、124.38,曲线下面积(AUC)值为0.784、0.898、0.889,联合诊断的AUC值为0.967。结论TEG参数及PLR是伴CSVD的急性脑梗死患者HT发生风险的影响因素,且对预后具有一定预测价值。Objective To study the value of thromboelastography(TEG)combined with platelet/lymphocyte ratio(PLR)in assessing the risk of hemorrhagic transformation(HT)after acute cerebral infarction with small vessel disease(CSVD).Methods Ninety-seven patients with acute cerebral infarction with CSVD in our hospital from January 2019 to December 2021 were selected and divided into HT group and non HT group according to whether HT occurred within 7 days of admission.The general data,TEG parameters and PLR values of the two groups were compared.The influencing factors of HT were analyzed,and the predictive value of TEG parameters combined with PLR was evaluated by subject operating characteristics(ROC).Results Twenty-three of ninety-seven patients with acute cerebral infarction with CSVD developed HT,and the incidence of HT was 23.71%.There was no significant difference between the two groups in gender,age,BMI,basic diseases,time from onset of symptoms to treatment location of cerebral infarction,and antithrombotic therapy(P>0.05).The proportion of severe and dual antiplatelet in HT group was higher than that in non HT group(P<0.05).There was not statistically significant difference in K,MA,αof the two groups(P>0.05).R,LY30 and PLR in HT group were higher than those in non HT group(P<0.05).Logistic regression analysis showed that large area cerebral infarction,high signal grade of CSVD white matter,dual antiplatelet therapy,R,LY30and PLR were the risk factors of HT(P<0.05).The ROC analysis showed that the cut off values of TEG parameters R,LY30 and PLR in the diagnosis of HT were 6.00 min,2.352%and 124.38,the AUC values were 0.784,0.898 and0.889,and the AUC value of combined diagnosis was 0.967.Conclusion CSVD is a risk factor for patients with acute cerebral infarction and has certain prognostic value.

关 键 词：脑小血管病 急性脑梗死 血栓弹力图 血小板/淋巴细胞比值 出血性转化 风险评估 

分 类 号：R743[医药卫生—神经病学与精神病学]