急性脑梗死患者血栓弹力图与凝血功能的关系

Relationship between thrombus elasticity and coagulation function in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者血栓弹力图(TEG)与凝血功能的相关性。方法选择2018年1月至2019年2月空军军医大学第二附属医院唐都医院收治的76例ACI患者作为观察组,同时期在我院体检的健康志愿者100例作为对照组。比较两组受检者的TEG和凝血功能指标,再比较观察组中不同梗死面积组、神经缺损程度组患者的TEG和凝血指标。Pearsom相关性分析TEG与凝血功能指标的相关性。结果观察组与对照组受检者的凝血反应时间(R)[(5.32±0.42)min vs(6.43±0.95)min]、血细胞凝集块形成时间(K)[(2.21±0.79)min vs(2.89±0.96)min]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组与对照组受检者的血细胞凝集块形成速率(α角)[(61.35±8.54)deg vs(56.32±4.28)deg]、血凝块最大强度或硬度(MA)[(58.12±6.39)mm vs(52.14±4.17)mm]、凝血综合指数(Cl)(-0.23±0.06)vs(-1.57±0.44)、血小板聚集率[(65.32±12.51)%vs(53.21±9.75)%]、D-二聚体(DD)[(0.39±0.12)mg/L vs(0.25±0.06)mg/L]、血浆纤维蛋白原(FIB)[(4.65±0.69)g/L vs(2.71±0.46)g/L]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);R、K随着梗死面积的增大和神经缺损程度的增加而降低,α角、MA、Cl、血小板聚集率、DD、FIB则升高,差异均有统计学意义(P<0.05);Pearson相关分析结果显示,观察组中R、K与血小板聚集率、DD、FIB呈负相关(P<0.05),α角、MA、Cl与血小板聚集率、DD、FIB呈正相关(P<0.05)。结论ACI患者TEG参数均与血小板聚集率、DD、FIB存在明显相关性,可用作评价ACI发生、病情严重程度的辅助指标。

Objective To investigate the correlation between thrombus elasticity(TEG)and coagulation function in patients with acute cerebral infarction(ACI).Methods Seventy-six ACI patients(observation group)and 100 healthy volunteers(control group)admitted to Tangdu Hospital,the Second Affiliated Hospital of Air Force Military Medical University,from January 2018 to February 2019 were selected as subjects.The TEG and coagulation function index was compared between the observation group and the control group,and also between the groups with different infarct area and nerve defect degree.Pearson correlation analysis was used to analyze the correlation between TEG and coagulation function index.Results In the observation group,the clotting reaction time(R)and the time of clot formation was(K)were(5.32±0.42)min and(2.21±0.79)min,significantly shorter than(6.43±0.95)min,(2.89±0.96)min in the control group(P<0.05).The clot formation rate(αangle),the maximum strength or hardness of blood clot(MA),coagulation complex index(CL),platelet aggregation rate,D-Dimer(DD),and fibrinogen(FIB)in the observation group were significantly higher than those in the control group(P<0.05):αangle,(61.35±8.54)deg vs(56.32±4.28)deg;MA,(58.12±6.39)mm vs(52.14±4.17)mm;CL,(-0.23±0.06)vs(-1.57±0.44);platelet aggregation rate,(65.32±12.51)%vs(53.21±9.75)%;DD,(0.39±0.12)mg/L vs(0.25±0.06)mg/L;FIB,(4.65±0.69)g/L vs(2.71±0.46)g/L.With the increase of infarction area and the increase of the nerve defect degree,R and K decreased,whileαangle,MA,Cl,platelet aggregation rate,DD and FIB increased,with statistically significant difference(P<0.05).Pearson correlation analysis showed that,in observation group,R and K were negatively correlated with platelet aggregation rate,DD and FIB(P<0.05),whileαangle,MA,and Cl were positively correlated with platelet aggregation rate,DD and FIB(P<0.05).Conclusion TEG parameters in ACI patients are significantly correlated with platelet aggregation rate,DD and FIB,which could be used as an auxiliary indicator to evaluate the occurrence and severity of ACI.