急性缺血性脑卒中双抗治疗后血栓弹力图监测

A clinical study of thrombelastogram monitoring after double-antibody therapy of acute ischemic stroke

目的探讨血栓弹力图(TEG)在急性缺血性脑卒中双抗治疗中对疗效评估的监测价值。方法选取2011年6月至2016年6月秦皇岛市第一医院急性缺血性脑卒中患者70例为研究对象,所有患者均接受氯吡格雷+阿司匹林双抗治疗,根据治疗结束后1月疗效情况分为预后优良组(n=38)和不良组(n=32),分析两组年龄、性别、治疗1周时神经功能缺损评分(NIHSS评分)、凝血指标及TEG相关指标[凝血反应时间(R)、血细胞凝集块形成时间(K)、血栓最大振幅(MA)、α角]差异,并进行多因素分析,观察TEG指标与NIHSS评分的相关性,并将其纳入ROC曲线模型观察其预测双抗治疗后疗效的可行性。结果治疗1 d时R和K水平较治疗前显著升高,MA较治疗前显著降低,差异有统计学意义(P<0.05)。多因素分析结果显示NIHSS评分、R及MA是影响患者预后的独立因素,差异有统计学意义(P<0.05)。TEG指标R和K与NIHSS评分呈显著负相关性(r=-0.965 9、-0.831 9),MA和α角与NIHSS评分呈显著正相关性(r=0.799 3、0.954 7),差异均有统计学意义(P<0.05)。ROC分析显示治疗1周时R和MA预测患者预后的曲线下面积分别为0.851和0.869。结论急性缺血性脑卒中患者双抗治疗后早期监测血栓弹力图有助于判断患者预后,为临床治疗提供依据。

Objective To study the monitoring value of thrombelastogram（TEG） in evaluating the curative effect ofdouble-antibody therapy in patients with acute ischemic stroke. Methods The retrospective analysis was used to analyzethe clinical data of 70 patients with acute ischemic stroke from June 2011 to June 2016 in our hospital. All patients receivedclopidogrel plus aspirin dual antiplatelet therapy. After 1 courses of treatment,the patients were divided into good prognosisgroup（n=38）and bad group（n=32）accorded to the curative effect after the end of the treatment for one mouth. The age,gender,national institutes of health stroke scale（NIHSS）score in 1 week of treatment,blood coagulation index TEG andrelated indicators[reactiontime（R）,kineticsofclot development（K）,maximum amplitude（MA）,α]differences of the twogroups were compared followed with multi factor analysis;the correlation between TEG index and NIHSS score wereanalyzed,and the ROC curve model was used to observe the feasibility of dual antiplatelet therapy after the prediction effect.Results When treated for 1 day,the levels of R and K were significantly higher than those before treatment,and MA wassignificantly lower than that of before treatment;the difference was statistically significant（P〈0.05）. The multivariateanalysis showed that the NIHSS score,R and MA were independent factors affecting the prognosis of patients（P〈0.05）.The TEG index,R and K were negatively correlated with the NIHSS score（r=-0.965 9,-0.831 9）. There was a significantpositive correlation between MA and alpha angle and NIHSS score（r=0.799 3,0.954 7）;the ROC showed that the R andMA predicted AUC in patients were 0.851 and 0.869,respectively at 1 week. Conclusion The early monitoring of thrombela-stogram in patients with acute chemic stroke is helpful to judge the prognosis of patients with acute chemic stroke,and providethe basis for clinical treatment.