血栓弹力图在不同进展期急性脑梗死患者中的临床应用

Clinical study of thrombelastogram in patients with acute cerebral infarction

目的观察急性脑梗死患者不同进展期血栓弹力图(TEG)的变化情况,并评价其在急性脑梗死中的临床应用价值。方法采用全血复钙法,分别对121例治疗前的急性脑梗死患者(患者组,包括51例轻度脑梗死、37例中度脑梗死和33例重度脑梗死)和60例健康体检者(对照组)进行TEG检测,包括凝血反应时间(R)、凝血形成时间(K)、凝固角(α角)、最大振幅(MA)、凝血指数(CI)和30min血凝块幅度减少速率(LY30),同时进行凝血试验检测,比较各组间TEG参数的差异,并对TEG参数与凝血试验参数相关性进行分析。结果患者组R、K低于对照组,而α角和MA高于对照组,纤维蛋白原(FIB)和D-二聚体水平高于对照组,差异均有统计学意义(P<0.05);患者组CI、LY30与对照组比较,差异无统计学意义(P>0.05);重度组与轻度组和中度组急性脑梗死患者比较,TEG参数中R、K、α角、MA的改变差异有统计学意义(P<0.05);重度组患者D-二聚体水平也显著高于轻度组和中度组(P<0.05);与轻度组比较,中度组TEG参数中的R、K、α角和MA变化差异有统计学意义(P<0.05);急性脑梗死患者TEG各参数与凝血指标相关性分析显示,R、K与PT-INR呈正相关,与FIB和D-二聚体水平呈负相关,α角和CI与PT-INR、FIB和D-二聚体均呈正相关,MA与活化部分凝血活酶时间、FIB和D-二聚体呈正相关,与PT-INR呈负相关(P<0.05)。结论TEG在急性脑梗死诊断、严重程度评价及病情监测中具有重要的临床应用价值,可在临床上推广应用。

Objective To observe the changes of thrombelastogram(TEG)in patients with acute cerebral infarction and to assess their clinical value.Methods TEG(including R,K,α-angle,MA,CI,and LY30)were measured for 121 patients with acute cerebral infarction(patients group,including 51 mild infarction,37 moderate infarction and 33 severe infarction)and 60 healthy individuls(control group)by using whole blood calcium-recovery method.The levels of these parameters were compared between the patient group and the control group.Coagulation tests were also done for those people.The correlations between parameters of TEG and coagulation tests were analyzed.Results Significant changes in the R,K,α-angle,MA,FIB,and D-dimer was observed between the patients group and the control group(P<0.05),while there was no statistical significance in CI and LY30(P>0.05).Among the groups with different severity,R,K,α-angle,MA,and D-dimer,there were significantly different in the severe group from other groups,while R,K,α-angle,and MA were significantly different from those in the mild and moderate group(P<0.05).Pearson correlation analysis revealed that R and K were positively related to PT-INR,and negatively related to FIB and D-dimer.α-angle and CI were positively related to PT-INR,FIB,and D-dimer.MA was positively related to APTT,FIB,and D-dimer,and negatively related to PT-INR(P<0.05).Conclusion The TEG could be a useful tool in diagnosis,evaluation of severity and monitoring of cerebral infarction.