血栓弹力图在轻中度急性脑梗死患者早期神经功能恶化中的预测作用

Predictive role of thromboelastography in early neurological deterioration in patients with mild to moderate acute cerebral infarction

目的探讨血栓弹力图(TEG)对轻中度急性脑梗死患者早期神经功能恶化(END)的预测价值。方法选取2017年10月至2018年10月哈尔滨医科大学附属第二医院神经内科治疗的轻中度急性脑梗死患者216例,依据住院72 h是否发生END分为END组66例、非END组150例,比较2组TEG参数变化,多因素logistic回归分析TEG参数变化对END的影响,ROC曲线分析TEG参数预测END发生的效能。结果END组动力时间(K时间)[(1.2±0.4)min]、反应时间(R时间)[(3.8±1.2)min]均较非END组[(1.2±0.4)min、(4.5±0.8)min]缩短,差异有统计学意义(P<0.05),最大振幅(MA)、血块强度G、α角、估计溶解百分率(EPL)、30 min溶解百分率(LY30)、凝血系数(CI)、药物使用后剩余血块强度A值与非END组比较差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,R时间缩短(OR=1.82,95%CI:1.17~2.45,P=0.024)是发生END的独立危险因素;ROC曲线示R时间以4.0 min为最佳界值,预测急性脑梗死患者发生END的AUC为0.713(95%CI:0593~0.834,P=0.000),灵敏性为72.7%,特异性为61.3%。结论对于轻中度急性脑梗死患者,其TEG检测指标R时间缩短,R时间为4.0 min对患者72 h内发生END有一定预测作用。

Objective To investigate the predictive value of thromboelastogram(TEG)for early neurological deterioration(END)in patients with mild to moderate acute cerebral infarction.Methods 216 patients with mild to moderate acute cerebral in farction treated by neurology in the Second Affiliated Hospital of Harbin Medical University from October 2017 to October 2018 were recruited.According to the hospitalization of 72 hours,END was divided into END group of 66 cases and non-END group of 150 cases.The two groups were compared with TEG parameters.Multivariate logistic regression analysis of TEG parameters was performed on END.Impact,ROC curve analysis TEG parameters predict the effectiveness of END occurrence.Results The END group dynamic time(K time)[(1.2±0.4)min],reaction time(R time)[(3.8±1.2)min]were lower than that in the non-END group[(1.2±0.4)min,(4.5±0.8)min](P<0.05).There were no significant differ ence in the residual blood clot A value,maximum amplitude(MA),clot strength G,alpha angle,estimated percent dissolu tion(EPL),30 min dissolution percentage(LY30),coagula tion coefficient(CI)between the drug and the non-END group(P>0.05).The multivariate logistic regression analysis showed that the R time was shortened(OR=1.82,95%CI:1.17-2.45,P=0.024),indicating that it wass an independent risk factor for END.ROC curve indicated that R time was 4.0 min as the best cut-off value,and the AUC of END in patients with acute cerebral infarction was predicted to be 0.713(95%CI:0593-0.834,P=0.000).The sensitivity was 72.7%and the specificity was 61.3%.Conclusion For patients with mild to moderate acute cerebral infarction without intravenous thrombolysis,the R time of TEG detection index is short ened,and the R time of 4.0 min has a certain predictive effect on END within 72 h.