血栓弹力图血小板功能对脑出血进展及预后的评估价值

Application value of thrombelastograph platelet function in evaluating the progression and prognosis of cerebral hemorrhage

目的探讨未使用抗血小板药物的脑出血患者的血小板功能与疾病进展及预后的关系。方法回顾性分析2015年1月-2019年12月重庆医科大学附属第一医院神经外科收治的129例脑出血患者的临床资料,将其分为脑出血再出血组(53例)与未再出血组(76例),比较两组入院未使用抗血小板药物情况下的血栓弹力图指标,包括R值、K值、Angle角、花生四烯酸(AA)抑制率、二磷酸腺苷(ADP)抑制率等与再出血及预后的关系,以及与格拉斯哥昏迷量表评分的相关性。结果再出血组AA抑制率和ADP抑制率均明显高于未再出血组,差异有统计学意义(P=0.015、0.025);再出血组死亡患者AA抑制率和ADP抑制率均明显高于生存组,差异有统计学意义(P=0.022、0.030);AA抑制率和ADP制率与格拉斯哥昏迷量表评分呈负相关(r=–0.183,P=0.038;r=–0.175,P=0.047)。结论血栓弹力图血小板功能可作为预警指标辅助评估脑出血患者的再出血风险及预后情况。

Objective To explore the relationship between platelet function and disease progression and prognosis in patients with cerebral hemorrhage without antiplatelet agents.Methods A retrospective analysis was performed on the clinical data of 129 patients with intracerebral hemorrhage who were admitted to the Neurosurgical Department,the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019.These patients were divided into two groups:rebleeding group after intracerebral hemorrhage(n=53)and non-rebleeding group(n=76).The relation of thrombelastograph parameters including R value,K value,Angle of view,and the inhibition rates of arachidonic acid(AA)and adenosine diphosphate(ADP)under the condition without use of antiplatelet drugs at admission and their correlation with Glasgow Coma Scale score were compared between the two groups.Results The AA inhibition rate(P=0.015)and ADP inhibition rate(P=0.025)in rebleeding group were statistically higher than those in non-rebleeding group.AA inhibition rate of platelet function(P=0.022)and ADP inhibition rate(P=0.030)in rebleeding death group were statistically higher than those in survival group.AA inhibition rate(r=–0.183,P=0.038)and ADP inhibition rate(r=–0.175,P=0.047)were negatively correlated with Glasgow Coma Scale score.Conclusions Thrombelastographic detection of platelet function can be used as an early warning indicator to assist the assessment of the risk of rebleeding and prognosis in patients with intracerebral hemorrhage.