非溶栓急性缺血性脑卒中患者凝血常规和血栓弹力图变化及其与临床症状相关性分析

Changes of conventional coagulation and thromboelastogram in patients with acute ischemic cerebral stroke and its correlation with clinical symptoms

目的探讨非溶栓急性缺血性脑卒中患者凝血常规和血栓弹力图(thromboelastograghy,TEG)参数的变化与临床症状之间的关系以及其对预后的影响。方法选取2017年1月至2017年12月在我院神经科住院的急性缺血性脑卒中非溶栓患者99例,同时选取排除缺血性脑卒中的神经科其他住院患者35例作为对照组,对其一般临床资料进行分析,并对凝血常规和TEG指标进行检测,根据美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分将卒中组分为轻度卒中组48例,中重度卒中组51例,后者根据病程30 d时NIHSS评分改善情况和改良Rankin量表(modified Rankin Scale,mRS)评分进一步分为预后良好组及预后不良组。比较各组TEG参数之间的差异,分析其与症状严重程度及预后的关系。结果与对照组相比,脑卒中组部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer,D-D)均增高,并且在中重度卒中组升高更为明显(P<0.05);中重度卒中组中血栓最大振幅和血凝块力学强度G值及血凝块形成速率明显高于对照组(P<0.05)。与中重度卒中组相比,轻度卒中组凝血反应时间和血凝块形成时间明显增高(P<0.05),FIB和血凝块溶解百分比明显降低(P<0.05)。预后不良组的K值明显低于预后良好组(P<0.05)。结论卒中患者血液呈高凝状态,凝血常规联合TEG参数检测可能对判断卒中严重程度及衡量患者预后具有重要临床意义。

Objective To investigate the relationship between conventional coagulation,thromboelastography (TEG) and the severity of symptoms in patients with acute ischemic cerebral stroke and analyze its impact on prognosis.Methods Conventional coagulation tests and thromboelastography were performed and analyzed in 99 patients who were hospitalized in the department of neurology in our hospital from January 2017 to December 2017.At the same time,35 other inpatients in neurology department excluding ischemic stroke were selected as the control group to analyze the general clinical data,and to detect the routine coagulation and TEG indexes.According to the national institute of health stroke scale (NIHSS) score,48 patients were divided into mild stroke group and 51 patients with moderate-to-severe stroke group.Patients with moderate to severe stroke were further divided into better prognosis group and poor prognosis group according to the improvement of NIHSS score and modified Rankin Scale (mRS) score at 30 days.Compare the differences between the TEG of each group,and analyze its relationship with the severity of symptoms and prognosis.Results Compared with the control group,activated partial thromboplastin time (APTT),fibrinogen (FIB) and D-dimer (D-D) were increased in patients with stroke,and the increase was more significant in the moderate-to-severe stroke group (P<0.05).The maximum amplitude of thrombus,G value of mechanical strength of blood clot and the rate of blood clot formation in the moderate-to-severe stroke group were significantly higher than those in the control group (P<0.05).Compared with the moderate-to-severe stroke group,the clotting reaction time and clot formation time were significantly increased in mild stroke group (P<0.05),FIB and the percentage of clot dissolved decreased significantly (P<0.05).The K value of patients with poor prognosis was significantly lower than those with better prognosis (P<0.05).Conclusion The blood of patients with acute cerebral ischemic stroke is hypercoagulable.Conventional coagulation test combined with TEG may have important clinical implications for determining the severity and prognosis of acute ischemic cerebral stroke.