TEG参数HbA1c联合梗死体积对急性缺血性脑卒中患者治疗后颅内出血的预测价值  

The predictive value of TEG parameters and HbA1c combined with infarct volume for post-treatment intracranial hemorrhage in patients with acute ischemic stroke

作　　者：徐艳丽[1] 卢才磊 张晓钰 Xu Yanli;Lu Cailei;Zhang Xiaoyu(The Third People's Hospital of Anyang,Anyang 455000,Henan,China)

机构地区：[1]安阳市第三人民医院,河南安阳455000

出　　处：《临床心身疾病杂志》2024年第3期26-30,共5页Journal of Clinical Psychosomatic Diseases

基　　金：国家神经系统疾病临床医学研究中心重大研究项目(编号0527)。

摘　　要：目的探讨血栓弹力图(TEG)参数、糖化血红蛋白(HbA1c)联合磁共振弥散加权成像(DWI)梗死体积对急性缺血性脑卒中(AIS)患者治疗后颅内出血的预测价值。方法对接受静脉溶栓治疗的184例AIS患者的临床资料进行回顾性分析。比较发生和未发生颅内出血患者临床资料、TEG参数、HbA1c及DWI梗死体积等差异,采用Logistic回归分析探讨AIS患者发生颅内出血影响因素,采用受试者工作特征(ROC)曲线分析TEG参数、HbA1c联合DWI梗死体积预测颅内出血的应用价值。结果184例患者中,发生颅内出血43例,颅内出血发生率为23.37%。发生颅内出血患者入院时美国国立卫生研究院卒中量表(NIHSS)评分、HbA1c、D-二聚体(D-D)和降钙素原(PCT)水平高于未发生颅内出血患者(P<0.01)。发生颅内出血患者R值(凝血反应时间)、K值(血细胞凝集块形成时间)、DWI梗死体积大于未发生颅内出血患者,而Angle值(血细胞凝集块形成速率)、MA值(最大血块强度)、CI值(凝血指数)小于未发生颅内出血患者(P<0.05或0.01)。Logistic回归分析结果显示,R值、DWI梗死体积、HbA1c是AIS患者发生颅内出血的影响因素(P<0.01)。R值、DWI梗死体积、HbA1c三项指标联合预测颅内出血的ROC曲线下面积为0.828,灵敏性和特异性分别为83.70%和65.20%。结论TEG参数、HbA1c联合DWI梗死体积在预测AIS患者治疗后颅内出血方面有较好的应用价值,值得临床使用。Objective To explore the predictive value of thromboelastography(TEG)parameters and glycosylated hemoglobin(HbA1c)plus diffusion-weighted imaging(DWI)infarct volume for posttreatment intracranial hemorrhage in patients with acute ischemic stroke(AIS).Methods Clinical data of 184 AIS patients undergoing intravenous thrombolysis were retrospectively analyzed.The differences in clinical data,TEG parameters,HbA1c,and DWI infarct volume were compared between patients with and without intracranial hemorrhage,factors influencing the occurrence of intracranial hemorrhage in AIS patients explored using Logistic regression analysis,and predictive values of TEG,DWI infarct volume,and HbA1c combination for intracranial hemor rhage analyzed adopting receiver operating characteristic(ROC)curve.Results Among 184 patients,43 ones developed intracranial hemorrhage,and the incidence of intracranial hemorrhage was 23.37%.Score on the National Institutes of Health Stroke Scale(NIHSS)as well as HbA1c,D-dimer(D-D),and procalcitonin(PCT)level on admission were higher in patients with than ones without intracranial hemor rhage(P<0.01).R(coagulation reaction time)and K(formation time of blood cell clots)value as well as DWI infarct volume were larger and Angle(formation rate of blood cell clots),MA(maximum blood clot strength),and CI(coagulation index)value were smaller in patients with than ones without intracranial hemorrhage(P<0.05 or 0.01).Logistic regression analysis showed that R value,DWI infarct volume,and HbA1c were the factors inf luencing the occur rence of intracranial hemorrhage in AIS patients(P<0.01).The area under the ROC curve of R value,DWI infarct volume,and HbA1c combination predicting intracranial hemorrhage was 0.828,sensitivity and specificity were respectively 83.70%and 65.20%.Conclusion The TEG parameters and HbA1c plus DWI infarct volume has a good application value in predicting post-treatment intracranial hemorrhage in AIS patients and is worthy of clinical use.

关 键 词：急性缺血性脑卒中 颅内出血 血栓弹力图 糖化血红蛋白 梗死体积 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]