急性脑梗死早期经替奈普酶溶栓治疗后凝血指标变化研究  

Study on changes of coagulation index after teneplase thrombolytic therapy in early stage of acute cerebral infarction

作　　者：高天初 李盼[1] 苑聪聪 张丽[1] Gao Tianchu;Li Pan;Yuan Congcong;Zhang Li(Department of Neurology,the Baoding NO.1 Central Hospital,Hebei 071000,China)

机构地区：[1]保定市第一中心医院神经内科,河北0710000

出　　处：《脑与神经疾病杂志》2024年第12期750-754,共5页Journal of Brain and Nervous Diseases

基　　金：河北省卫生健康委员会医学科学研究课题计划项目(20232027)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)患者经替奈普酶(TNK)溶栓前后凝血相关指标的变化及与临床预后的关系。方法回顾性分析2022年6月至2023年12月在保定市第一中心医院就诊的AIS患者126例,且均使用TNK进行溶栓治疗。观察患者溶栓前及溶栓后24 h血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MVP)、血小板压积(PCT)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原含量(Fbg)、凝血酶时间(TT)、D-二聚体(D-D)及美国国立卫生研究院卒中量表(NIHSS)评分的变化。结果经TNK溶栓治疗后,化验结果中除PLT外,其余PDW、MVP、PCT、PT、APTT、Fbg、TT、INR及D-D等化验指标前后变化差异均有统计学意义(P<0.05)。采用多因素Logistic回归分析溶栓后症状加重的危险因素,结果显示T-T延长(OR=1.45,95%CI:1.02~2.06,P<0.05)及D-D升高(OR=1.40,95%CI:1.15-1.51,P<0.01)是影响症状加重的危险因素,而APTT延长(OR=0.73,95%CI:0.59~0.89,P<0.01)是影响症状加重的保护因素。ROC工作曲线显示,D-D对TNK溶栓后症状加重的诊断特异度为0.81,灵敏度为0.96,最佳临界值为2.35;APTT对TNK溶栓后症状加重的诊断特异度为0.74,灵敏度为0.71,最佳临界值为26.15。结论AIS早期患者经TNK溶栓治疗后,部分凝血相关指标在溶栓前后有较为明显的变化,且与患者预后有一定关系。Objective To investigate the changes of blood coagulation indexes before and after teneplase(TNK)thrombolysis in patients with acute ischemic stroke(AIS)and the relationship with clinical prognosis.Methods A retrospective analysis was performed on 126 AIS patients treated in the First Central Hospital of Baoding City from June 2022 to December 2023,all of whom were treated with TNK for thrombolytic therapy.Platelet(PLT),platelet distribution width(PDW),mean platelet volume(MVP),platelet volume(PCT),prothrombin time(PT),activated partial thrombin time(APTT),fibrinogen(Fbg),thrombin time(TT)and D-dimer(D-D)were observed before and24 hours after thrombolysis and the National Institutes of Health Stroke Scale(NIHSS)score.Results After TNK thrombolytic therapy,except for PLT,the changes of PDW,MVP,PCT,PT,APTT,Fbg,TT,INR and D-D were statistically significant(P<0.05).Multivariate Logistic regression was used to analyze the risk factors for exacerbation of symptoms after thrombolysis,and the results showed that T-T prolongation(OR=1.45,95%CI:1.02-2.06,P<0.05)and increased D-D(OR=1.40,95%CI:1.15-1.51,P<0.01)were risk factors for worsening symptoms,while prolonged APTT(OR=0.73,95%CI:0.59-0.89,P<0.01)were protective factors for worsening symptoms.ROC curves showed that the diagnostic specificity and sensitivity of D-D for symptom exacerbation after TNK thrombolytic therapy were 0.81,0.96,and the optimal critical value was 2.35.The diagnostic specificity and sensitivity of APTT for symptom exacerbation after TNK thrombolysis were 0.74,0.71,and the optimal critical value was 26.15.Conclusion After TNK thrombolysis in patients with AIS,some coagulation-related indexes changed significantly before and after thrombolysis,which was related to the prognosis of patients.

关 键 词：急性缺血性脑卒中 替奈普酶 凝血 溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]