冠状动脉粥样硬化、急性脑梗死患者血栓弹力图血小板图参数、血小板凝集功能及其之间的关系  

Thromboelasto Graphy-Platelet Mapping Parameters,Platelet Agglutination Function and Their Relationship in Patients with Coronary Atherosclerosis and Acute Cerebral Infarction

作　　者：李师亮 冯异 程才[1] 郑萍[1] LI Shiiang;FENG Yi;CHENG Cai;ZHENG Ping(Department of Heart and Macrovascular Surgery,Tongji Hospital,Tongji Medical College of HUST,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,湖北省武汉市430000

出　　处：《实用心脑肺血管病杂志》2025年第1期44-49,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：湖北省科技重大专项项目(2022ACA002)。

摘　　要：目的分析冠状动脉粥样硬化(CAA)、急性脑梗死(ACI)患者血栓弹力图血小板图(TEG-PM)参数、血小板凝集功能情况及其之间的关系。方法选取2020-01-01至2022-01-01华中科技大学同济医学院附属同济医院收治的CAA患者73例为CAA组及ACI患者66例为ACI组。选取同期在华中科技大学同济医学院附属同济医院体检中心进行健康体检者52例为对照组。根据疾病严重程度,将CAA组患者进一步分为Ⅰ级亚组(冠状动脉无明显狭窄,n=20)、Ⅱ级亚组(冠状动脉狭窄率为40%~69%,n=19)、Ⅲ级亚组(冠状动脉狭窄率为70%~99%,n=20)、Ⅳ级亚组(冠状动脉完全闭塞,n=14),将ACI组患者进一步分为轻度亚组[美国国立卫生研究院卒中量表(NIHSS)评分为1~4分,n=35]、中度亚组(NIHSS评分为5~15分,n=15)、重度亚组(NIHSS评分≥16分,n=16)。比较CAA组与对照组、ACI组与对照组及不同疾病严重程度CAA、ACI患者TEG-PM参数[凝血反应时间(R)、血细胞凝集块形成时间(K)、血细胞凝集块形成速率(α角)、最大振幅(MA)、花生四烯酸(AA)途径抑制率、二磷酸腺苷(ADP)途径抑制率]、血小板凝集率。采用Pearson相关分析探讨CAA、ACI患者TEG-PM参数与血小板凝集率的相关性。结果CAA组、ACI组R、K短于对照组,α角、MA大于对照组,AA途径抑制率、ADP途径抑制率低于对照组,血小板凝集率高于对照组(P<0.05)。Pearson相关分析结果显示,CAA组、ACI组R、K、AA途径抑制率、ADP途径抑制率均与血小板凝集率呈负相关,α角、MA均与血小板凝集率呈正相关(P<0.05)。Ⅱ级亚组、Ⅲ级亚组、Ⅳ级亚组R短于Ⅰ级亚组,Ⅲ级亚组、Ⅳ级亚组R短于Ⅱ级亚组,Ⅳ级亚组R短于Ⅲ级亚组(P<0.05);Ⅲ级亚组、Ⅳ级亚组K短于Ⅰ级亚组,Ⅳ级亚组K短于Ⅱ级亚组(P<0.05);Ⅲ级亚组、Ⅳ级亚组MA大于Ⅰ级亚组,Ⅲ级亚组MA大于Ⅱ级亚组(P<0.05);Ⅱ级亚组、Ⅲ级亚组、Ⅳ级亚组AA途径抑制率低于Ⅰ级亚组,Objective To analyze the parameters of thromboelasto graphy-platelet mapping(TEG-PM),platelet agglutination function and their relationship in patients with coronary artery atherosclerosis(CAA)and acute cerebral infarction(ACI).Methods A total of 73 patients with CAA and 66 patients with ACI admitted to Tongji Hospital,Tongji Medical College of HUST from 2020-01-01 to 2022-01-01 were enrolled as CAA group and ACI group respectively.A total of 52 individuals who underwent physical examination in the physical examination center of Tongji Hospital,Tongji Medical College of HUST were selected as the control group.According to the severity of the disease,patients in CAA group were further divided into classⅠsubgroup(no significant coronary artery stenosis,n=20),classⅡsubgroup(coronary artery stenosis 40%-69%,n=19),classⅢsubgroup(coronary artery stenosis 70%-99%,n=20)and classⅣsubgroup(complete coronary artery occlusion,n=14),patients in ACI group were further divided into mild subgroup[National Institutes of Health Stroke Scale(NIHSS)score of 1-4,n=35],moderate subgroup(NIHSS score of 5-15,n=15),and severe subgroup(NIHSS score≥16,n=16).TEG-PM parameters[coagulation reaction time(R),formation time of blood cell agglutination block(K),formation rate of blood cell aggregates(αangle),maximum amplitude(MA),arachidonic acid(AA)pathway inhibition rate,adenosine diphosphate(ADP)pathway inhibition rate]and platelet agglutination rate were compared between CAA group and control group,between ACI group and control group,among CAA and ACI patients with different disease severity.Pearson correlation analysis was used to investigate the correlation between TEG-PM parameters and platelet agglutination rate in CAA and ACI patients.Results R and K in CAA group and ACI group were shorter than those in control group,αangle and MA were larger than those in control group,inhibition rate of AA pathway and ADP pathway was lower than that in control group,and platelet agglutination rate was higher than that in control group(P<0.0

关 键 词：冠状动脉疾病 冠状动脉粥样硬化 脑梗死 血栓弹力图血小板图 血小板凝集功能 

分 类 号：R543.3[医药卫生—心血管疾病] R743.33[医药卫生—内科学]