血栓弹力图用于急性缺血性脑卒中患者早期神经功能恶化预测价值的探讨

Clinical value of thromboelastogram as a predictor of early neurological deterioration in patients with acute ischemic stroke

目的探讨基线血栓弹力图(TEG)用于急性缺血性脑卒中患者早期神经功能恶化(END)预测的临床价值。方法回顾性分析运城市中心医院2015年1月至2019年1月收治的发病时间<24 h、美国国立卫生研究院卒中量表(NIHSS)评分<16分急性缺血性脑卒中患者219例的临床资料,其中68例出现END设为A组,151例未出现END设为B组,比较两组基线临床资料和TEG指标,采用logistic回归模型分析急性缺血性脑卒中患者END发生的危险因素。结果A组男性比例(58.82%)和吸烟比例(20.59%)均显著低于B组(80.79%,38.41%)(χ^(2)=11.40、4.45,均P<0.05);A组合并糖尿病比例(41.18%)、基线NIHSS评分[(5.23±1.90)分]及血清超敏C反应蛋白(hs-CRP)水平[(4.62±0.72)mg/L]均显著高于B组[19.21%,(2.40±1.35)分,(1.70±0.49)mg/L](χ^(2)=5.89,t=2.26、3.27,均P<0.05);A组凝血反应时间(RT)[(4.10±1.08)min]和凝血形成时间(KT)[(1.33±0.30)min]均显著少于B组[(4.41±1.35)min,(1.56±0.42)min](t=-3.72、-3.30,均P<0.05);A组RT缩短比例(82.35%)和KT缩短比例(22.06%)均显著高于B组(58.28%,7.95%)(χ^(2)=5.86、4.55,均P<0.05);logistic回归模型分析结果显示,RT缩短是急性缺血性脑卒中患者END发生的独立危险因素(OR=1.82,P<0.05);同时合并糖尿病、基线NIHSS评分及血清hs-CRP水平亦与急性缺血性脑卒中END发生相关(OR=2.95、1.38、1.61,均P<0.05)。结论TEG凝血时间RT缩短可用于轻中度急性缺血性脑卒中END发生预测;临床医师可据此早期评估病情转归并给予针对性干预,从而进一步改善患者临床预后。

Objective To investigate the clinical value of baseline thromboelastogram as a predictor of early neurological deterioration in patients with acute ischemic stroke.Methods The clinical data of 219 patients with acute ischemic stroke with onset time<24 hours and National Institute Health of Stroke Scale(NIHSS)score<16 points who received treatment in Yuncheng Central Hospital,China between January 2015 and January 2019 were retrospectively analyzed.These patients were divided into groups A(with early neurological deterioration,n=68)and B(without early neurological deterioration,n=151).Baseline data and thromboelastogram indices were compared between the two groups.Logistic regression was used to analyze the risk factors of early neurological deterioration in patients with acute ischemic stroke.Results The proportion of male patients and the proportion of smokers in the group A were 58.82%and 20.59%,respectively,which were significantly lower than those in the group B(80.79%,38.41%,χ^(2)=11.40,4.45,both P<0.05).The proportion of patients with acute ischemic stroke complicated by diabetes mellitus,baseline National Institute Health of Stroke Scale score and serum high-sensitivity C-reactive protein level in the group A were 41.18%,(5.23±1.90)points and(4.62±0.72)mg/L,respectively,which were significantly higher than those in the group B[19.21%,(2.40±1.35)points,(1.70±0.49)mg/L,χ^(2)=5.89,t=2.26,3.27,all P<0.05)].Coagulation reaction time and clotting time in the group A were(4.10±1.08)minutes and(1.33±0.30)minutes,respectively,which were significantly shorter than those in the group B[(4.41±1.35)minutes,(1.56±0.42)minutes,t=-3.72,-3.30,both P<0.05).The proportion of patients with shortened coagulation reaction time and the proportion of patients with shortened clotting time in the group A were 82.35%and 22.06%,respectively,which were significantly higher than those in the group B(58.28%,7.95%,χ^(2)=5.86,4.55,both P<0.05).Logistic regression model analysis showed that shortening of coagulation reaction time is an independent risk factor of early neurological deterioration(OR=1.82,P<0.05).Diabetes mellitus,baseline National Institute Health of Stroke Scale score and serum high-sensitivity C-reactive protein level were also associated with the occurrence of early neurological deterioration in acute ischemic stroke(OR=2.95,1.38,1.61,all P<0.05).Conclusion Shortening of coagulation reaction time can be used as a predictor of early neurological deterioration in mild and moderate acute ischemic stroke.Clinicians can evaluate the course of the disease and give targeted interventions according to early neurological deterioration,so as to further improve the clinical prognosis.