血栓弹力图与血浆EETs评估急性脑梗死严重程度的应用价值

Application value of thromboelasmogram and plasma EETs level in evaluating the severity of acute cerebral infarction

目的探讨血栓弹力图(TEG)参数与血浆二十碳三烯酸(EETs)在不同严重程度脑梗死患者中的变化趋势,并分析TEG各参数与EETs水平的相关性,同时探讨影响急性脑梗死患者神经功能缺损严重程度的因素。方法选择2018年7月至2019年11月在合肥市第二人民医院全科医学科住院并经头颅CT或MRI等诊断为急性脑梗死患者120例,根据美国国立卫生研究院卒中量表(NIHSS)评分将患者分为轻度组35例、中度组43例和重度组42例。检测所有患者的TEG各参数、颈动脉内膜以及EETs水平。采用方差分析比较三组间血栓弹力图各参数、EETs含量的差异;采用行×列表χ2检验比较颈动脉内膜情况;采用Pearson相关性分析急性脑梗死血栓弹力图各参数与EETs的相关性;采用二分类Logistic回归分析影响脑梗死患者预后的危险因素和保护因素,并绘制受试者工作特征曲线(ROC)。结果三组患者的TEG参数、颈动脉内膜厚度及EETs水平比较差异均有统计学意义(P<0.05);重度组患者的K值为(2.11±0.50)min,明显短于轻度组、中度组的(2.93±0.77)min、(2.44±0.54)min,R值为(6.99±1.51)min,明显短于轻度组、中度组的(8.04±2.28)min、(7.18±1.31)min,差异均有统计学意义(P<0.05);重度组患者的Angle值为(61.12±7.70)deg,明显大于轻度组、中度组的(53.85±8.08)deg、(58.42±7.33)deg,MA值为(65.76±7.55)mm,也明显大于轻度组、中度组的(57.84±6.67)mm、(62.96±6.75)mm,差异均有统计学意义(P<0.05);重度组患者的EETs值为(42.06±11.62)pg/mL,明显低于轻度组、中度组的(56.03±13.14)pg/mL、(52.59±12.40)pg/mL,差异均具有统计学意义(P<0.05);不同严重程度脑梗死患者的颈动脉内膜分布比较差异具有统计学意义(P<0.05);Pearson相关性分析结果显示,血浆EETs水平与Angle、MA值水平呈负相关(r=-0.233、-0.199,P<0.05);采用二分类Logistic回归分析发现,TEG参数Angle和MA值是急性脑梗死患者神经功能恶化的独立危险因素(P<0.05),而K值及血浆EETs是急性脑梗死神经功能良好的保护因素(P<0.05);ROC曲线分析显示,EETs=51.765 pg/mL为神经功能严重缺损的最佳预测临界值(曲线下面积为0.734,敏感性为61.5%,特异性为81%);TEG参数K值=1.95 min为脑梗死神经功能严重缺损的最佳诊断临界值(曲线下面积为0.694,灵敏度为88.5%,特异度为54.8%),而TEG其他参数预测脑梗死患者严重程度的曲线下面积均小于EETs、K值。结论不同严重程度脑梗死患者血TEG各参数、EETs及颈动脉内膜指标均明显不同;颈动脉粥样硬化的程度与脑梗死严重程度有关;急性脑梗死患者TEG各参数与血浆EETs之间存在较强的相关性,高Angle值、高MA值是急性脑梗死患者神经功能恶化的危险因素,高K值及高血浆EETs是预示急性脑梗死神经功能良好的保护因素。

Objective To investigate the variation trend of thrombolastogram(TEG)and plasma eicosatrienoic acid(EETs)levels in patients with different severity of cerebral infarction,and to analyze the correlation between TEG parameters and EETs levels,and to explore the factors affecting the severity of neurological impairment in patients with acute cerebral infarction.Methods From July 2018 to November 2019,120 patients with acute cerebral infarction diagnosed by head CT or MRI in Department of General Practice,the Second People’s Hospital of Hefei were selected.According to the National Institutes of Health Stroke Scale(NIHSS)score,the patients were divided into the mild group(35 cases),the moderate group(43 cases),and the severe group(42 cases).TEG parameters,carotid intima,and EETs levels were measured in all patients.Variance analysis was used to compare the differences of each parameter and EETs content in thromboelastic diagram between three groups.The carotid intima parameters were compared by the chi-square test.Pearson correlation was used to analyze the correlation between EETs and each parameter of TEG in acute cerebral infarction.Risk factors and protective factors influencing prognosis of cerebral infarction patients were analyzed by binary Logistic regression,and receiver operating characteristic(ROC)curve was drawn.Results TEG parameters,carotid intimal thickness,and EETs levels of the three groups were compared,and the differences were statistically significant(P<0.05).In the severe group,the K value was(2.11±0.50)min,which was significantly shorter than(2.93±0.77)min in the mild group and(2.44±0.54)min in the moderate group,and the R value was(6.99±1.51)min,which was significantly shorter than(8.04±2.28)min in the mild group and(7.18±1.31)min in the moderate group,with statistically significant differences(P<0.05).The Angle value of the patients in the severe group was(61.12±7.70)deg,which was significantly higher than(53.85±8.08)deg in the mild group and(58.42±7.33)deg in the moderate group,and MA value was(65.76±7.55)mm,which was also significantly higher than(57.84±6.67)mm in the mild group and(62.96±6.75)mm in the moderate group,all with statistically significant difference(P<0.05).The EETs value of patients in the severe group was(42.06±11.62)pg/mL,which was significantly lower than(56.03±13.14)pg/mL in the mild group and(52.59±12.40)pg/mL in the moderate group,and the differences was statistically significant(P<0.05).There were statistically significant differences in carotid intima distribution among patients with different severity of cerebral infarction(P<0.05).Pearson correlation analysis showed that plasma EETs levels were negatively correlated with Angle and MA levels(r=-0.233,-0.199,P<0.05).Binary Logistic regression analysis showed that TEG parameters Angle and MA were independent risk factors for neurological deterioration in patients with ACUTE cerebral infarction(P<0.05),while K value and plasma EETs were protective factors for neurological deterioration in patients with acute cerebral infarction(P<0.05).ROC curve analysis showed that EETs=51.765 pg/mL was the best predictive critical value(area under the curve was 0.734,sensitivity was 61.5%,specificity was 81%).TEG parameter K value=1.95 min was the critical value of optimal diagnosis of severe neurological defect in cerebral infarction(area under the curve was 0.694,sensitivity was 88.5%,specificity was 54.8%),while the area under the curve predicted by other TEG parameters for severity of cerebral infarction was less than EETs and K value.Conclusion Blood TEG parameters,EETs,and carotid intima indexes were significantly different in patients with cerebral infarction of different severity.The degree of carotid atherosclerosis was related to the severity of cerebral infarction.There was a strong correlation between TEG parameters and plasma EETs levels in patients with acute cerebral infarction.High Angle values and high MA values were risk factors for neurological deterioration in patients with acute cerebral infarction,and high K values and plasma EETs were protective factors that predicted good neurological function in patients with acute cerebral infarction.