高血压性脑出血患者急性期凝血功能与远期预后的关系研究  

Relationship between coagulation function and long-term prognosis of patients with hypertensive intracerebral hemorrhage during acute stage

作　　者：苏彦娥 冯飞雪 周嘉迪 胡卫敏 王瑾 张毅 刘一霏 SU Yan’e;FENG Feixue;ZHOU Jiadi;HU Weimin;WANG Jin;ZHANG Yi;LIU Yifei(Department of Clinical Laboratory,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712000,China;Department of Brain Surgery,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712000,China;Department of Blood Transfusion,The Second Affiliated Hospital of Xi’an Medical University,Xi’an,Shaanxi 710005,China)

机构地区：[1]陕西中医药大学附属医院检验科,陕西咸阳712000 [2]陕西中医药大学附属医院脑外科,陕西咸阳712000 [3]西安医学院第二附属医院输血科,陕西西安710005

出　　处：《中华神经外科疾病研究杂志》2025年第2期61-65,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：陕西重点研发计划(L2022ZDYFSF002)。

摘　　要：目的探讨高血压性脑出血(HICH)患者急性期凝血功能与远期预后的关系研究。方法采用前瞻性队列研究,选取2021年9月至2023年9月在陕西中医药大学附属医院确诊的126例HICH患者,根据神经功能缺损量表(mNIHSS)分为轻度组(n=48)、中度组(n=46)和重度组(n=32),比较三组患者的凝血功能指标。采用Pearson相关性分析mNIHSS评分与凝血功能指标的相关性。随访1年,根据改良Rankin量表得分(mRS),分为良好组(mRS≤2分,n=88)和不良组(mRS>2分,n=38),比较两组凝血功能指标。采用受试者工作特征(ROC)曲线分析各凝血功能指标以及联合检测对HICH患者远期预后不良的预测价值。结果中度组、重度组HICH患者的凝血功能指标[活化部分凝血酶时间(APTT)、凝血酶原时间(TT)、凝血酶时间(PT)、纤维蛋白原(FIB)、D-二聚体(DD)]水平均高于轻度组,重度组HICH患者的APTT、TT、PT、FIB及DD水平均高于中度组(P<0.05)。Pearson相关性分析显示,HICH患者mNIHSS评分与APTT、TT、PT、FIB、DD等凝血功能指标均呈正相关(r=0.381、0.359、0.370、0.423、0.414,P<0.05)。不良组HICH患者的APTT、TT、PT、FIB及DD水平均高于良好组(P<0.05)。ROC曲线分析可见,APTT、TT、PT、FIB及DD及联合检测预测急性期HICH患者远期预后不良的曲线下面积(AUC)分别为0.713、0.629、0.707、0.751、0.732、0.818,敏感度分别为77.27%、70.45%、73.86%、81.82%、79.55%、96.40%;特异度分别为71.05%、68.42%、71.05%、76.32%、73.68%、65.79%(P<0.05)。结论不同严重程度急性期HICH患者的凝血功能水平具有明显差异,且其水平变化与远期不良预后有关,联合检测对远期预后不良情况具有较好的预测价值。Objective To explore the relationship between coagulation function and longterm prognosis of patients with hypertensive intracerebral hemorrhage(HICH)during acute stage.Methods In the prospective cohort study,126 patients with HICH confirmed in the hospital between September 2021 and September 2023 were enrolled.According to scores of modified National Institutes of Health Stroke Scale(mNIHSS),they were divided into mild group(n=48),moderate group(n=46)and severe group(n=32),and coagulation function indexes in the three groups were compared.The correlation between mNIHSS scores and coagulation function indexes was analyzed by Pearson correlation analysis.According to scores of modified Rankin scale(mRS)after 1 year of follow-up,patients were divided into good prognosis group(≤2 points,n=88)and poor prognosis group(>2 points,n=38),and coagulation function indexes in the two groups were compared.The predictive value of coagulation function indexes for poor long-term prognosis of HICH patients was analyzed by receiver operating characteristic(ROC)curves.Results In the severe group and the moderate group,activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB)and D-dimer(DD)gradually decreased(P<0.05).Pearson correlation analysis showed that mNIHSS score was positively correlated with APTT,TT,PT,FIB and DD(r=0.381,0.359,0.370,0.423,0.414,P<0.05).APTT,TT,PT,FIB and DD in poor prognosis group were higher than those in good prognosis group(P<0.05).ROC curves analysis showed that AUC,sensitivity and specificity of APTT,TT,PT,FIB,DD and combined detection for predicting poor long-term prognosis of HICH patients during acute stage were(0.713,0.629,0.707,0.751,0.732,0.818),(77.27%,70.45%,73.86%,81.82%,79.55%,96.40%)and(71.05%,68.42%,71.05%,76.32%,73.68%,65.79%)respectively(P<0.05).Conclusions There are significant differences in coagulation function levels among patients with different severity of HICH during acute stage.The changes of coagulation function are related to poor long

关 键 词：高血压性脑出血 急性期 凝血功能 远期预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]