血栓弹力图中血栓最大幅度值与急性冠状动脉综合征患者冠状动脉血栓病变的关系

Relationship Between Maximal Amplitude of Thrombelastography and Intracoronary Thrombus in Patients With Acute Coronary Syndrome

目的：血栓弹力图是临床用于检测患者即时全血出凝血状态的检测工具,通过对急性冠状动脉综合征（ACS）患者进行血栓弹力图出凝血功能检测,了解血栓病变与血栓弹力图参数之间的关系,评估患者血栓风险,指导临床抗栓治疗方案。方法：纳入ACS患者共328例,均给予规范双联抗血小板治疗及经皮冠状动脉介入治疗（PCI）术前常规肝素,PCI术后12 h内抽取血样,进行相关实验室检测及血栓弹力图检测分析。结果：根据冠状动脉造影结果分为：血栓组及非血栓组。血栓组共66例,男性58例,女性8例;非血栓组262例,男性212例,女性50例。实验室检查结果显示：血栓组患者白细胞计数（P=0.02）、甘油三酯（P=0.003）及空腹血糖（P=0.024）较高,而非血栓组患者高密度脂蛋白胆固醇水平较高,差异有统计学意义（P=0.009）。Logistic回归分析显示：冠心病、血栓最大幅度（MA值）、血凝块强度（G值）、血浆纤维蛋白原、白细胞、甘油三酯以及空腹血糖都是血栓病变的危险因素（P〈0.05）,且既往冠心病病史（P=0.018,比值比=2.197,95%可信区间：1.146~4.212）以及MA值（P=0.006,比值比=1.138,95%可信区间：1.038~1.248）是ACS发生血栓病变的独立预测因子。结论：血栓弹力图检测中的MA值是预测ACS患者血栓负荷的有效指标,对明确诊断冠心病的患者进行血栓弹力图评估能够在临床对抗血小板治疗效果进行初步评估。

Objective： Thrombelastography（TEG） has been widely used for real-time monitoring of coagulation and bleeding systems. We want to investigate the relationship between intracoronary thrombotic lesion and TEG parameters in acute coronary syndrome（ACS） patients or guiding antithrombotic therapy. Methods： A total of 328 ACS patients were enrolled in our research. All patients received standard dual antiplatelet therapy and routine pre-PCI treatment by heparin. Blood samples were collected at 12 h after PCI to conduct laboratory test and TEG analysis.Results： According to coronary angiography（CAG）, the patients were divided into 2 groups： Thrombus group, n=66 including 58 male and 8 female and Non-thrombus group, n=262. In comparison, the patients in Thrombus group had the higher levels of white blood cell（WBC）（P=0.02）, triglyceride（P=0.003） and fasting glucose（P=0.024）; while Non-thrombus group had the higher level of HDL-C（P=0.009）. Logistic regression analysis indicated that coronary artery disease（CAD）,the maximal amplitude（MA） value of thrombus, intensity of clot（G value）, blood levels of fibrinogen, WBC, TG and fasting glucose were the risk factors for thrombotic lesion occurrence, all P0.05; previous history of CAD（P=0.018, OR=2.197, 95% CI 1.146-4.212） and MA value（P =0.006, OR=1.138, 95% CI 1.038-1.248） were the independent predictors for thrombotic lesion occurrence in ACS patients. Conclusion： MA value of TEG is an effective predictor of thrombus burden in ACS patients; it may preliminarily assess the effect of antiplatelet therapy in clinical practice.