血栓弹力图在急性冠脉综合征中的临床应用

The clinical application of thrombelastogram to acute coronary syndrome

目的探讨血栓弹力图在急性冠脉综合征中的诊断价值。方法将2017年11月~2019年12月于本院就诊的50例急性冠脉综合征患者纳为研究对象,所有患者均行抗血小板治疗与经皮冠状动脉介入术,治疗后行实验室检测及血栓弹力图检测,依据冠状动脉造影检查结果分为血栓组(n=22)与无血栓组(n=28)。比较两组实验室相关指标及血栓弹力图指标,分析筛选出导致血栓病变的危险因素。结果血栓组既往冠心病史患者比例高于无血栓组(P<0.05)。实验室检查结果及血栓弹力图检测结果显示,两组间三酰甘油、高密度脂蛋白胆固醇、D-二聚体、MA值、G值比较,差异有统计学意义(P<0.05或P<0.01)。经Logistic回归分析显示,既往冠心病史、三酰甘油升高、高密度脂蛋白胆固醇下降、D-二聚体下降、MA值与G值的升高均是导致血栓弹力图在急性冠脉综合征患者形成血栓的危险因素(P<0.05或P<0.01)。结论血栓弹力图在急性冠脉综合征的诊断中可较好地反映患者血液高凝状态,MA值与G值的升高可成为评估患者血栓负荷的有效指标。

Objective To explore the diagnostic value of thrombelastogram for acute coronary syndrome(ACS).Methods From November 2017 to December 2019,50 patients with ACS in our hospital were selected as the subjects of research.All the patients were treated with antiplatelet therapy and percutaneous coronary intervention(PCI).After treatment,laboratory examination and thrombelastogram detection were conducted.The patients were divided into the thrombotic group(n=22)and the non-thrombotic group(n=28)according to the results of coronary arteriography.The laboratory related indexes and thrombelastogram indexes of the two groups were compared,and the risk factors leading to thrombosis were analyzed and screened out.Results The proportion of patients with previous history of coronary heart disease(CHD)in the thrombotic group was higher than that in the non-thrombotic group(P<0.05).The results of laboratory examination and thrombelastogram detection showed that there were significant differences between the two groups in triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),D-Dimer concentration,MA value,and G value(P<0.05 or P<0.01).Logistic regression analysis showed that previous history of CHD,the increase of TG,the decrease of HDL-C,the decrease of D-Dimer concentration,and the increase of MA value and G value were all the risk factors leading to thrombus in the patients with ACS detected by thrombelastogram(P<0.05 or P<0.01).Conclusion In the diagnosis of ACS,thrombelastogram can better reflect the high blood coagulation state,and the increase of intensity value of blood platelet and G value can become effective indicators to evaluate thrombus burden in patients.