血栓弹力图联合年龄血压临床特征和持续时间2评分预测短暂性脑缺血发作进展为脑梗死的临床价值

The value of thromboelastography combined with the ABCD2 score in predicting cerebral infarction resulting from a transient ischemic attack

目的探讨血栓弹力图(thrombelastography,TEG)联合年龄血压临床特征和持续时间2评分(age,blood pressure,clinical feature,duration of sympotoms,diabetes,ABCD2)预测短暂性脑缺血发作(transient ischemic attack,TIA)进展为脑梗死的临床价值。方法选择开平市中心医院2019年1月至2021年1月收治的110例初诊TIA患者作为研究对象,所有研究对象均进行ABCD2评分及TEG检查,随访3个月,以头颅磁共振成像检查结果为金标准,记录脑梗死发生情况,根据是否发生脑梗死分为脑梗死组和非脑梗死组,比较两组患者ABCD2评分及TEG参数(反应时间、凝固时间、凝固角、最大凝固振幅),采用Spearman相关性分析和logistic多元线性回归分析TEG参数、ABCD2评分对TIA进展为脑梗死的影响。结果随访3个月,27例患者进展为脑梗死,发生率为24.55%。脑梗死组患者ABCD2评分明显高于非脑梗死组,反应时间、凝固时间明显短于非脑梗死组,凝固角、最大凝固振幅明显大于非脑梗死组,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,ABCD2评分、凝固角、最大凝固振幅与脑梗死发生均呈正相关,差异有统计学意义(r值分别为0.527、0.120、0.372,P<0.05),反应时间、凝固时间与脑梗死发生均呈负相关,差异有统计学意义(r值分别为-0.428、-0.325,P<0.05)。Logistic多元线性回归分析结果显示,ABCD2评分高、反应时间短、凝固时间短、最大凝固振幅小是TIA进展为脑梗死的危险因素,差异有统计学意义(P<0.05)。结论TEG联合ABCD2评分预测TIA发作进展为脑梗死具有良好的预警作用,ABCD2评分越高,反应时间、凝固时间越短,最大凝固振幅越大,脑梗死发生风险越大。

Objective To determine the value of thromboelastography(TEG)combined with the ABCD2score in predicting cerebral infarction resulting from a transient ischemic attack(TIA).Methods A total of 110 newly-diagnosed patients with TIAs in our hospital were selected as the study subjects.The ABCD2scores and TEG findings were reviewed.All the patients were followed for 3 months.The occurrence of cerebral infarctions were based on head MRI examination(the gold standard)results.All the patients were divided into cerebral and non-cerebral infarction groups,and the ABCD2 score and TEG parameters(reaction time,coagulation time,coagulation angle,and maximum coagulation amplitude)of the groups were compared.Spearman correlation analysis and logistic multiple linear regression were used to analyze the effects of TEG parameters and the ABCD2 score on the progression of a TIA to cerebral infarction.Results There were 27 patients with TIAs who progressed to cerebral infarctions;the incidence of cerebral infarction was24.55%.The ABCD2 score of patients in the cerebral infarction group was significantly higher than the noninfarction group,the reaction and coagulation times were significantly shorter than the non-infarction group,and the coagulation angle and maximum amplitude were significantly larger than the non-infarction group(P<0.05).The Spearman correlation analysis showed that the ABCD2 score,coagulation angle,and maximum amplitude were positively correlated with the occurrence of cerebral infarction(r=0.527,0.120,0.372,respectively;P<0.05).The reaction and coagulation times were negatively correlated with the occurrence of cerebral infarction(rvalues were-0.428 and-0.325,respectively;P<0.05).Logistic multiple linear regression analysis showed that the ABCD2 score,response time,coagulation time,and maximum amplitude were the main risk factors affecting the progression of a TIA to a cerebral infarction(P<0.05).Conclusion Thromboelastic charts combined with an ABCD2 score predict the progression of a TIA to a cerebral infarction.The larger the ABCD2 score,the smaller the response and coagulation times,the larger the maximum amplitude,and the greater the risk of a cerebral infarction.