缺血性脑卒中溶栓患者出凝血变化规律的探讨

Study on the changes of coagulation function in ischemic stroke patients with thrombolysistherapy

目的通过观察急性缺血性脑卒中患者组织型纤溶酶原激活物(rt-PA)静脉溶栓前后凝血及血小板指标变化的规律,进一步探讨与病情转归及临床预后的关系。方法选取2017年11月至2018年10月在本院就诊的急性缺血性卒中并进行rt-PA静脉溶栓治疗患者54例,检测患者溶栓前及溶栓后24 h的凝血及血小板指标,包括血小板(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D二聚体(DD)、纤维蛋白/原降解产物(FDP)、纤溶酶原(PLG)、血管性血友病因子含量(vWF:Ag)、血管性血友病因子活性(vWF:A)、凝血因子Ⅱ、凝血因子Ⅶ、凝血因子Ⅷ、凝血因子Ⅹ,同时记录患者入院时及静脉溶栓24 h的美国国立卫生研究院卒中量表(NIHSS)评分。分析患者溶栓前和溶栓后24 h凝血及血小板指标的变化;轻型卒中(NIHSS评分≤5分)和重型卒中(NIHSS评分≥6分)2组患者溶栓前各项指标变化;溶栓后24 h的NIHSS评分升高组及降低组患者各项指标变化。结果溶栓后24 h跟溶栓前相比,PT、APTT、MPV增高,FIB、PLG、vWF:Ag、vWF:A、凝血因子Ⅷ降低,差异有统计学意义(P<0.05)。重型卒中和轻型卒中2组患者相比,凝血因子Ⅱ、凝血因子Ⅶ明显增高,差异有统计学意义(P<0.05)。溶栓后24 h时NIHSS评分升高组和NIHSS评分降低组相比,PLG明显降低,vWF:Ag、vWF:A明显升高,差异有统计学意义(P<0.05)。结论急性缺血性脑卒中溶栓后24 h的凝血指标及血小板功能有较为明显的变化,并与病情的严重程度及预后均有较密切的联系,通过对以上指标进行观察能辅助预后和评估出血转化,对指导治疗有积极的临床意义。

Objective The changes of coagulation and platelet indexes before and after intravenous thrombolysis of tissue plasminogen activator(rt-PA)were observed in patients with acute ischemic stroke,and the relationship between the changes and clinical prognosis was further explored.Methods Fifty-four patients with acute ischemic stroke who were treated with rt-PA intravenous thrombolysis in our hospital from November 2017 to October 2018 were selected.The coagulation and platelet parameters of patients before and 24 hours after thrombolysis were measured.The blood coagulation and platelet parameters,including platelet(PLT),mean platelet volume(MPV),platelet distribution width(PDW),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT),D-dimer(DD),fibrin/fibrinogen degration(FDP),plasminogen(PLG),von Willebrand factor content(vWF:Ag),von Willebrand factor activity(VWF:A),coagulation factorⅡ,coagulation factorⅦ,coagulation factorⅧ,and coagulation factor X,and the NIHSS scores of patients at the time of admission and 24 hours of intravenous thrombolysis were recorded.The changes of coagulation and platelet indexes before and 24 hours after thrombolysis were analyzed,and the changes of indexes before thrombolysis in light stroke(NIHSS score≤5 points)and heavy stroke(NIHSS score≥6 points)were analyzed.24 hours after thrombolysis,the NIHSS scores of the two groups increased and decreased.Results Compared with that before thrombolysis,PT,APTT and MPV increased,FIB,PLG,vWF:AG,vWF:A and coagulation factorⅧdecreased 24 hours after thrombolysis(P<0.05).The levels of coagulation factorⅡand coagulation factorⅦwere significantly higher in severe stroke group than in light stroke group(P<0.05).At 24 hours after thrombolysis,PLG,vWF:Ag and vWF:a were significantly higher in the NIHSS group than in the NIHSS group(P<0.05).Conclusion There are obvious changes in coagulation index and platelet function 24 hours after thrombolysis in acute ischemic stroke,and they are closely related to the severity and prognosis of the disease.The observation of the above indexes can assist the prognosis and evaluate the transformation of hemorrhage,which has positive clinical significance for guiding the treatment.