血栓弹力图预测急性脑梗死静脉溶栓后早期神经功能恶化的研究

Thromboelastography predicts early neurological deterioration in acute ischemic stroke patients undergoing intravenous thrombolysis

目的探讨血栓弹力图(thrombelastography,TEG)对急性脑梗死静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的预测作用。方法回顾性分析于2017―2019年在东莞市人民医院神经内科接受阿替普酶(recombinant tissue plasminogen activator,r-tPA)静脉溶栓的急性脑梗死患者。END定义为入院72 h内美国国立卫生研究院卒中评分(National Institute of Health Stroke Score,NIHSS)较入院基线评分增加≥2分或运动评分项增加≥1分。临床研究的参数包括年龄、性别、血管危险因素、NIHSS评分、发病至治疗时间(onset to treatment time,OTT)、溶栓前血压、血液学指标以及血栓弹力图最大振幅(maximum amplitude,MA)、反应时间(reaction time,R)、凝固时间(clotting time,K)、凝固角(clotting alpha,α)结果。定义MA值≥75%百分位数为MA75。结果29例(18.8%)患者出现END。选取MA75、糖尿病史、OTT、血小板计数(P<0.1)进入二元Logistic回归方程,结果显示,MA75(OR=2.754,95%CI=1.091-6.949,P=0.032)与END有关。结论血栓弹力图中的MA对急性脑梗死静脉溶栓后早期神经功能恶化有预测作用。

Objective To assess whether thromboelastography could predict early neurological deterioration(END)in acute ischemic stroke(AIS)patients treated with recombinant tissue plasminogen activator(r-tPA).Methods Data collected prospectively for continuous patients with AIS treated with r-tPA from 2017-2019 were retrospectively analyzed.END was defined as that the National Institutes of Health Stroke Scale(NIHSS)score increased≥2 or the motor score increased≥1 with in 72 h after admission compared with the baseline score on admission.Clinical variables studied included age,gender,vascular risk factors,NIHSS score,onset to treatment time(OTT),blood pressure before intravenous thrombolysis(IVT),initial hematologic data and thromboelastography including maximum amplitude(MA),reaction time(R),clotting time(K),clotting alpha(α).MA75 was defined as≥75th percentile.Results Twenty-nine(18.8%)patients presented with END.MA75,diabetes mellitus,OTT,platelet counts(P<0.1)were entered into the binary Logistic regression model.The Logistic regression showed that MA75(OR=2.754,95%CI=1.091-6.949,P=0.032)was related to END significantly.Conclusion In patients with AIS treated with IVT,MA of thromboelastography might be a useful predictor for END.