血栓弹力图与凝血四项指标在急性冠脉综合征伴高脂血症患者再发急性心肌梗死中的预测价值研究  

Study on the predictive value of thrombelastogram and four coagulation indexes in recurrent acute myocardial infarction in patients with acute coronary syndrome and hyperlipidemia

作　　者：王涛[1] 朱华[1] 朱小波[1] 赵建平[1] WANG Tao;ZHU Hua;ZHU Xiaobo(Department of Laboratory,Taixing Second People's Hospital,Taixing 225411,China)

机构地区：[1]泰兴市第二人民医院检验科,江苏泰兴225411

出　　处：《医师在线》2025年第1期37-40,共4页Journal of Doctors Online

摘　　要：目的探究血栓弹力图(TEG)与凝血四项指标在急性冠脉综合征(ACS)伴高脂血症患者再发急性心肌梗死(AMI)中的预测价值。方法选取2021年1月~2023年3月在我院确诊的ACS伴高脂血症患者92例,根据是否再发AMI,分为再发组(n=24)和非再发组(n=68),所有患者均接受经皮冠状动脉介入术治疗和他汀类药物降脂治疗。比较两组患者的TEG参数、凝血四项指标水平;绘制受试者工作特征(ROC)曲线分析TEG参数与凝血四项指标对ACS伴高脂血症患者再发AMI的预测效能。结果再发组的凝血反应时间(R)、血液凝固时间(K)低于非再发组,凝固角(α)高于非再发组(P<0.05),两组血凝块最大强度(MA)比较无统计学差异(P>0.05);再发组的凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)均低于非再发组,纤维蛋白原(FIB)水平高于非再发组(P<0.05)。ROC曲线分析显示,R、K、α、PT、TT、APTT、FIB单独及联合检测在预测ACS伴高脂血症患者再发AMI的曲线下面积(AUC)分别为0.729、0.716、0.695、0.635、0.642、0.641、0.675、0.800,灵敏度分别为70.59%、67.65%、64.71%、58.82%、61.76%、61.76%、64.71%、96.00%,特异度分别为67.86%、63.79%、62.07%、60.34%、63.79%、60.34%、62.07%、60.34%(P<0.05)。结论TEG联合凝血四项指标检测对ACS伴高脂血症患者再发AMI具有较高的预测价值。Objective To investigate the predictive value of thrombelastogram(TEG)and four coagulation parameters in recurrent acute myocardial infarction(AMI)in patients with acute coronary syndrome(ACS)and hyperlipidemia.Methods A total of 92 patients with ACS with hyperlipidemia diagnosed in our hospital from January 2021 to March 2023 were selected.According to whether the recurrence of AMI,they were divided into recurrent group(n=24)and non-recurrent group(n=68).TEG parameters and blood coagulation levels were compared between the two groups.The predictive efficiency of TEG and four coagulation indexes on recurrent AMI in ACS patients with hyperlipidemia were analyzed by receiver operating characteristic(ROC)curve.Results The coagulation reaction time(R)and blood coagulation time(K)of recurrent group were lower than those in non-recurrent group,coagulation angle(α)was higher than that in non-recurrent group(P<0.05),and there was no significant difference in the maximum intensity(MA)of blood clots between the two groups(P>0.05).The prothrombin time(PT),thrombin time(TT)and activated partial thromboplastin time(APTT)in recurrent group were lower than those in non-recurrent group,and the fibrinogen(FIB)was higher than that in non-recurrent group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of R,K,α,PT,TT,APTT and FIB alone and combined detection in predicting the recurrence of AMI in ACS patients with hyperlipidemia were 0.729,0.716,0.695,0.635,0.642,0.641,0.675 and 0.800,respectively.The sensitivity were 70.59%,67.65%,64.71%,58.82%,61.76%,61.76%,64.71% and 96.00%,respectively.The specificity were 67.86%,63.79%,62.07%,60.34%,63.79%,60.34%,62.07% and 60.34%,respectively(P<0.05).Conclusion The detection of TEG combined with four coagulation indexes has a high predictive value for the recurrence of AMI in ACS patients with hyperlipidemia.

关 键 词：血栓弹力图 凝血四项 急性冠脉综合征 高脂血症 再发急性心肌梗死 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病] R589.2[医药卫生—内科学] R542.22[医药卫生—临床医学]