血栓弹力图与传统凝血指标预测脑卒中合并静脉血栓栓塞症的临床价值  

The clinical value of thromboelastography and traditional coagulation indexes in predicting cerebral apoplexy with venous thromboembolism

作　　者：贺扬欣 张萌[1] 崔颖 马峰[1] 岳彦伟 王宝燕[1] HE Yangxin;ZHANG Meng;CUI Ying;MA Feng;YUE Yanwei;WANG Baoyan(The First Affiliated Hospital of Xi′an Jiaotong University School of Medicine,Xi′an 710061,China)

机构地区：[1]西安交通大学医学院第一附属医院,陕西西安710061

出　　处：《西部医学》2024年第1期91-96,102,共7页Medical Journal of West China

基　　金：国家自然科学基金(81801122);陕西省自然科学基础研究计划项目(2020JQ-529)。

摘　　要：目的 探究血栓弹力图(TEG)与传统凝血指标在预测脑卒中血栓栓塞症的价值。方法 采用单中心回顾性横断面研究方法,连续性纳入2019年10月—2022年3月在我院输血科进行TEG检测的符合标准的脑卒中患者178例作为研究对象,入院后做TEG和抽血检查传统指标,根据影像学诊断结果分为单纯脑卒中组97例,合并静脉血栓栓塞症(VTE)组81例;合并VTE组患者根据改良Rankin量表(mRS)分为预后良好组59例,预后不良组22例。采用TEG分析仪检测TEG相关指标变化。采用全自动凝血分析仪检测传统凝血指标水平。采用Pearson分析传统凝血指标与TEG指标的关系;ROC曲线分析传统凝血指标与TEG指标对脑卒中合并VTE的预测价值。结果 合并VTE组患者R、K值均明显低于单纯脑卒中组,MA、CI值、Angle角均明显高于单纯脑卒中组,差异具有统计学意义(P<0.01)。合并VTE组患者FIB水平明显高于单纯脑卒中组,APTT、TT、PT水平均明显低于单纯脑卒中组,差异具有统计学意义(P<0.01)。FIB水平与R、K值呈负相关,与MA、CI值、Angle角呈正相关(均P<0.05);APTT与R、K值呈正相关(均P<0.05),与MA、CI值、Angle角呈负相关(均P<0.05),TT与R、K值呈正相关(均P<0.05),与MA、CI值、Angle角呈负相关(均P<0.05);PT与R、K值呈正相关(均P<0.05),与CI值、Angle角呈负相关(均P<0.05)。TEG各项指标联合检测预测脑卒中合并VTE的曲线下面积为0.927,传统凝血指标联合检测的曲线下面积为0.906。TEG各项指标联合检测预测脑卒中合并VTE患者预后的曲线下面积为0.889,传统凝血指标联合检测的曲线下面积为0.861,TEG对于脑卒中合并VTE患者预后的预测价值略高。结论 传统凝血指标与TEG指标对预测脑卒中血栓性栓塞具有一定价值,及时识别脑卒中患者血凝状态的异常,评价患者预后,但TEG略有优势,临床需相互结合,有利于早期预测疾病转归。Objective To explore the value of Thromboela-stography(TEG) and traditional predictors in predicting stroke thromboembolism.Methods Using a single center retrospective cross-sectional study method,178 stroke patients who met the criteria for TEG testing in the blood transfusion department of our hospital from October 2019 to March 2022 were consecutively included as the study objects.After admission,TEG and blood sampling were performed for traditional indicators.According to the imaging diagnosis results,they were divided into simple stroke group(n=97) and venous thromboembolism(VTE) group(n=81).The patients with VTE were divided into good prognosis group(n=59 cases) and poor prognosis group(n=22) according to the modified Rankin Scale(mRS).TEG analyzer was used to detect the changes of TEG related indexes(coagulation reaction time(R),blood clot formation time(K),maximum amplitude(MA) and coagulation index(CI)).The level of traditional coagulation indexes((fibrinogen,FIB),activated partial thromboplastin time(APTT),thrombin time(TT),and prothrombin time(PT)) were measured by automatic coagulation analyzer.Pearson was used to analyze the relationship between traditional coagulation indexes and TEG indexes;ROC curve was used to analyze the predictive value of traditional coagulation index and TEG index for stroke with VTE.Results The R and K values in patients with VTE were significantly lower than those in patients with simple stroke,and the MA,CI values and Angle angle were significantly higher than those in patients with simple stroke(P<0.01).The level of FIB in patients with VTE was significantly higher than that in patients with simple stroke,and the levels of APTT,TT and PT were significantly lower than those in patients with simple stroke(P<0.01).The level of FIB was negatively correlated with R and K,and positively correlated with MA,CI and Angle angle(P<0.05).APTT was positively correlated with R and K values,MA,CI values,and Angle angle(P<0.05),TT was positively correlated with R and K values,and negativ

关 键 词：脑卒中 血栓弹力图 凝血指标 血栓栓塞 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]