急性脑梗死患者凝血状态的变化及临床意义

Changes and Clinical Significance of Blood Coagulation in Patients With Acute Cerebral Infarction

目的探讨急性脑梗死急性发作时机体凝血状态的变化及其临床意义。方法选择在我院接受治疗的228例脑血栓形成所致急性脑梗死患者作为病例组,同期选择健康体检者202例为对照组,分别测定两组受试者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、抗凝血酶活性(AT:A)、凝血因子Ⅷ促凝活性(FⅧ:C)、纤溶酶原活性(PLG:A)、血管性血友病因子抗原(VWF:Ag)和蛋白C活性(PC:A),并进行比较分析。结果病例组患者血浆FIB、D-D、FⅧ:C、VWF:Ag水平均高于对照组(P<0.01);AT:A、PLG:A、PC:A水平均低于对照组(P<0.01);血浆PT、APTT水平与对照组比较差异无统计学意义(P>0.05)。受试者工作特征曲线(ROC)分析显示:PT、APTT、FIB、D-D、AT:A、FⅧ:C、PLG:A、VWF:Ag、PC:A的ROC曲线下面积分别0.418、0.428、0.687、1.000、0.064、0.950、0.368、0.949、0.414。结论急性脑梗死急性发作时凝血和继发性纤溶功能增强,抗凝功能减弱;联合检测这些项目可更好地了解患者的凝血状态,为早期诊断和治疗及临床预后提供比较确切的依据。

Objective To explore the changes of coagulation status and clinical significance in acute attack of acute cerebral infarction. Methods 228 patients with acute cerebral infarction caused by cerebral thrombosis in our hospital were selected as case group, at the same period, 202 healthy subjects were selected as control group, PT, APTT, FIB, D-D, AT： A, F Ⅷ ： C, PLG： A, VWF： Ag, PC： A in two groups were measured respectively, then compared and analyzed. Results The case group of FIB、D-D、F Ⅷ ： C、VWF： Ag levels were higher than control group（P 0.01）; The levels of AT： A、PLG： A and PC： A were lower than control group（P 0.01）; The plasma levels of PT and APTT were compared with control group（P 0.05）. ROC analysis showed： PT、APTT、FIB、D-D、AT： A、F Ⅷ ： C、PLG： A、VWF： Ag、PC： A were 0.428, 0.687, 0.418, 1, 0.064, 0.950, 0.368, 0.949, 0.414, respectively. Conclusion Coagulation and secondary fibrinolysis are enhanced and anticoagulant function impaired in acute cerebral infarction; Joint testing of these programs provides a better understanding of the patient＇s clotting status, it provides a more accurate basis for early diagnosis and treatment and clinical prognosis.