血栓弹力图与常规凝血试验评价老年无症状性脑梗死患者凝血功能的对比研究

Comparison on thromboelastography and conventional coagulation tests for evaluating blood coagulation function in elderly patients with asymptomatic cerebral infarction

目的探讨血栓弹力图(TEG)与常规凝血试验检测老年无症状性脑梗死(ACI)患者凝血状况的共性与差异,评价二种方法的应用价值。方法选取86例老年ACI急性期患者作为患者组,同期选取90名体检健康者作为对照组,所有受试者均同步进行TEG和常规凝血试验检测,患者组在治疗4周后再次进行上述检测。结果相关性分析显示,凝血反应时间(R)值与凝血酶原时间(PT)、凝血酶原时间国际标准化比值(PT-INR)呈正相关、与纤维蛋白原(Fib)呈负相关,血凝块最大强度或硬度(MA)值与Fib呈正相关,凝血综合指数(CI)与PT、PT-INR呈负相关,与Fib呈正相关。患者组治疗前与对照组相比,R值、血细胞凝集块形成时间(K)值、PT、PT-INR、活化部分凝血活酶时间(APTT)明显低于对照组,血细胞凝集块形成速率(α角)、MA值、CI、Fib明显高于对照组(P<0.05);治疗前、后对比,治疗后R值、K值、PT-INR、APTT增加,α角、MA值、CI、Fib降低(P<0.05);患者组治疗后与对照组相比,R值、K值、PT、PT-INR仍略低于对照组,α角、MA值、CI、Fib仍略高于对照组(P<0.05)。治疗前、后TEG和常规凝血试验结果的Kappa值分别为0.072(P>0.05)、0.124(P>0.05),χ~2值分别为13.40及7.60,P<0.01。另外,TEG结果显示治疗前、后凝血因子型高凝比例分别为4.65%和10.46%;血小板型高凝分别为23.26%和25.58%;血小板和凝血因子型高凝分别为40.70%和15.12%。结论 TEG和常规凝血试验一些指标间存在一定的相关性,常规凝血试验对老年ACI患者凝血功能的检测虽有一定效能但与TEG相比敏感性较差,TEG作为一种更灵敏、更全面的凝血功能检测手段,对老年ACI患者的早期辅助检测和指导临床治疗更具价值。

Objective To investigate the commonness and difference between thromboelastography(TEG)and conventional coagulation tests for evaluating blood coagulation function in elderly patients with asymptomatic cerebral infarction(ACI).Methods A total of86elderly patients with acute ACI(ACI group)and90healthy subjects(healthy control group)were enrolled.The2groups were determined by TEG and conventional coagulation tests simultaneously.After treatment for4weeks,TEG and conventional coagulation tests were performed as well in the2groups.Results The correlation analysis showed that reaction time(R)had positive correlations with prothrombin time(PT)and prothrombin time-international normalized ratio(PT-INR),and had a negative correlation with fibrinogen(Fib).Maximum clot strength(MA)was positively correlated with Fib,synthesize coagulation index(CI)was negatively correlated with PT and PT-INR,and CI was positively correlated with Fib.In ACI group,R,clotting time(K),PT,PT-INR and activated partial thromboplastin time(APTT)were lower than those in healthy control group,while angle(α),MA,CI and Fib were higher(P<0.05).After treatment,R,K,PT-INR and APTT were increased,andα,MA,CI and Fib were decreased(P<0.05).However,compared with healthy control group,after treatment,R,K,PT and PT-INR were still lower,andα,MA,CI and Fib were still higher than those in healthy control group(P<0.05).In ACI group,the Kappa values of TEG with conventional coagulation tests before and after treatment were0.072and0.124(P>0.05),andχ2were13.40and7.60(P<0.01).In addition,the results of TEG showed that the platelet hypercoagulabilities before and after treatment were4.65%and10.46%in ACI group,the enzymatic hypercoagulabilities were23.26%and25.58%,and the platelet and enzymatic hypercoagulabilities were40.70%and15.12%.Conclusions There is a correlation between some indicators of TEG and conventional coagulation tests.Conventional coagulation tests have a certain efficiency on the determination of blood coagulation function in elderly patients with ACI,but the sensitivity is poor compared with TEG.As a sensitive and comprehensive determination of blood coagulation function,TEG is useful for the early determination and clinical treatment of ACI for elderly patients.