血压晨峰及血栓弹力图与进展性脑梗死的相关性分析  

Correlation analysis of morning peak blood pressure and thromboelastogram with progressive cerebral infarction

作　　者：李宏锦 李景莉 李亚楠[1] 李英杰[1] 郭永勃[1] 孙丽燕 LI HongJin;LI Jingli;LI Ya’nan;LI Yingjie;GUO Yongbo;SUN Liyan(The 81st Group Military Hospital of the Chinese People’s Liberation Army,Zhangjiakou 075000,China)

机构地区：[1]中国人民解放军陆军第81集团军医院,河北张家口075000

出　　处：《中国实用神经疾病杂志》2023年第9期1062-1067,共6页Chinese Journal of Practical Nervous Diseases

基　　金：张家口市重点研发计划项目(编号:2021092D)。

摘　　要：目的探究血压晨峰及血栓弹力图与进展性脑梗死的相关性。方法选取2020-10—2022-09在陆军第81集团军医院神经内科住院的急性脑梗死患者152例,根据患者入院2周内是否出现进展性脑梗死分为试验组(53例,发生进展性脑梗死)、对照组(99例,未发生进展性脑梗死)。所有患者均于入院后24 h进行动脉血压及血栓弹力图数值检测,比较2组患者血压晨峰、血栓弹力图数值指标(最大血凝块强度、凝血综合指数、凝固角)差异,采用二元Logistics回归分析影响进展性脑梗死发病的因素,建立受试者工作特征(ROC)曲线,评估相关指标预测进展性脑梗死发病的价值。结果152例患者入院2周内出现进展性脑梗死53例,未出现99例,发生率为34.9%。与对照组相比,试验组血压晨峰值更高,最大血凝块强度、凝固角更大,血凝块形成时间更小(t=5.034、4.853、—4.271、7.029,P<0.05)。与对照组相比,试验组发病至治疗时间更长[(6.13±3.62)h比(4.45±2.41)h,t=3.418,P<0.05],纤维蛋白原水平更高[(3.61±1.24)g/L比(3.06±1.29)g/L,t=2.551,P<0.05],存在心房颤动占比更高(P<0.05)。Logistic回归分析显示血压晨峰值[OR=1.278,95%CI:1.078~1.515,P<0.05]、最大血凝块强度[OR=1.325,95%CI:1.03~1.704,P<0.05]、凝固角[OR=1.266,95%CI:1.072~1.495,P<0.05]、血凝块形成时间[OR=0,95%CI:0.000~0.000,P<0.05]、发病至治疗时间[OR=1.32,95%CI:1.008~1.729,P<0.05]是进展性脑梗死发生的影响因素(P<0.05)。血压晨峰值、最大血凝块强度、凝固角、血凝块形成时间联合预测进展性脑梗死的曲线下面积为0.963,敏感度、特异度分别为0.887、0.949,约登指数为0.836,界值为0.497。结论血压晨峰值、最大血凝块强度、凝固角、血凝块形成时间、发病至治疗时间是影响进展性脑梗死发病的因素,血压晨峰及血栓弹力图指标联合预测进展性脑梗死发病有一定临床参考价值。Objective To explore the crelation between moming peak blood pessure and thromboelastography with progressive cerebral infarction.Methods Totally 152 patients with acute cerebral infarction who were hospitalized in the Neurology Department of the 81st Group Military Hospital of the PLA from October 2020 to september,2022,were divided into the experimental group(53 patients with progressive cerebral infarction)and the control group(99 patients with no progressive cerebral infarction)based on whether they experienced progressive cerebral infarction within 2 weeks of admission.All patients were tested for arterial blood pressure and thromboelastogram values 24 hours after admission,and the differences between the two groups in the moming peak of blood pressure and thromboelastogram values(maximum blood clot strength,coagulation comprehensive index,coagulation angle)compared were.The binary Logistic regression was used to analyze the factors afcting the incidence of progressive cerebral infarction,establish the receiver operating characteristic(ROC)curve,and evaluate the value of related indicators in predicting the incidence of progressive cerebral infaretion.Results There were 53 cases of progressive cerebral infarction within 2 weeks of admission in 152 patients,and 99 cases did not occur,with an incidence rate of 34.9%.Compared with the control group,the experimental group had higher moming peak blood pressure,larger maximum blood clot strength,coagulation angle,and shorter elot formation time(t=5.034,4.853,-4.271,7.029,P<0.05).Compared with the control group,the experimental group had a longer time from onset to treatment[(6.13±3.62)hus(4.45±2.41)h,t=3.418,P<0.05],higher levels of fibrinogen[(3.61±1.24)g/L rs(3.06+1.29)g/L,=2.551,P<0.05],and a higher proportion of atrial fibillation(P<0.05).Logistie regression analysis showed that moming peak blood pressure[OR=1.278,95%CI:1.078-1.515,P<0.05],maximum clot strength[OR=1325,95%CI:1.03-1.704,P<0.05],coagulation angle|[0R=1.266,95%CI:1.072-1.495,P<0.05],elot forma

关 键 词：血压晨峰 血栓弹力图 进展性脑梗死 急性脑梗死 相关性 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]