血栓弹力图与常规凝血试验应用于脑血管疾病患者检测的相关分析

Correlation analysis of thromboelastogram and routine coagulation test in the detection of cerebrovascular diseases

目的探讨脑梗死与脑出血患者的血栓弹力图(TEG)检测各项参数的变化及其与常规凝血检测指标的关联性,比较二者在检测脑血管疾病患者凝血功能和状态方面的长短。方法收集本院神经外科从2018年1月1日~2019年3月26日同时做TEG和常规凝血试验的34例脑梗死(组)和102脑出血(组)的检测指标数据,以同期也做TEG和常规凝血检测的50名体检健康者作为对照组;比较3组对象TEG和常规凝血检测结果,并对TEG和常规凝血结果做相关性分析。结果 2个脑血管疾病组与健康对照组的TEG及常规凝血试验结果比较,脑梗死组R值明显降低,Angle角、MA距、CI值及Fib、D-D水平皆明显升高(P<0.05);脑出血组K值、Fib、TT、D-D均明显升高,Angle角、MA距则明显降低(P<0.05)。脑梗死与脑出血组的R值为5.06±1.71 vs 6.95±4.34、K时(min)为1.19±0.68 vs 3.43±1.46、TT(s)为13.89±1.05 vs 18.63±1.25、D-D(mg/L)为1.93±0.25 vs 2.63±0.45,Angle角(°)为69.34±10.37 vs56.54±10.48、MA(mm)距为68.34±9.37 vs 54.35±7.48;CI值为2.20±0.31 vs 0.78±0.41、Fib(mmg/L)为380±70.02vs 354±71.56(P<0.05)。脑梗死组的R值与APTT及Angle角,MA、CI值均与Fib呈正相关(P<0.05);K时与Fib, MA距与PT、TT,CI值与PT、APTT皆呈负相关(P<0.05)。脑出血组的R值与PT、APTT,K时与TT,Angle角与Fib呈正相关(P<0.05);R值、K时均与Fib, Angle与TT,CI值与PT呈负相关(P<0.05)。结论脑血管疾病患者TEG各个指标与常规凝血试验的D-D水平无相关性,Angle角与其升高的Fib呈正性相关性;MA距对于诊断脑梗死比脑出血更有意义。TEG与常规凝血试验具有互补作用,可作为评估脑血管病病情程度有益的实验室指标。

Objective To explore the changes of parameters of thromboelastogram(TEG)detection in patients with cerebral infarction and cerebral hemorrhage,and their correlation with routine coagulation indicators,and compare the two methods in detecting coagulation function and status in patients with cerebrovascular disease.Methods The detection data of 34 cases of cerebral infarction and 102 cases of cerebral hemorrhage,who underwent TEG and routine coagulation test in parallel,in Department of Neurosurgery of our hospital from January 1,2018 to March 26,2019 were collected.Fifty healthy subjects,who underwent TEG and routine coagulation tests in the same period,served as the control.The results of TEG and routine coagulation test of the 3 groups were compared and analyzed.Results Compared with cerebral hemorrhage(group)and the control,R value of cerebral infarction group decreased significantly,while the Angle angle,MA distance,CI value,Fib and D-D levels increased significantly(P<0.05);the K value,Fib,TT,and D-D of cerebral hemorrhage group increased significantly while Angle angle and MA distance decreased significantly compared with other two groups(P<0.05).The R value,K time(min),TT(s),D-D(mg/L),Angle angle(°),MA distance,CI value,and Fib(mmg/L)of cerebral infarction and cerebral hemorrhage group were 5.06±1.71 vs 6.95±4.34,1.19±0.68 vs 3.43±1.46,13.89±1.05 vs 18.63±1.25,1.93±0.25 vs 2.63±0.45,69.34±10.37 vs 56.54±10.48,68.34±9.37 vs 54.35±7.48,2.20±0.31 vs 0.78±0.41,and 380±70.02 vs 354±71.56(P<0.05).In cerebral infarction group,the R value,APTT,Angle angle,MA,and CI values were positively correlated with Fib(P<0.05);while K time was negatively correlated with Fib;MA distance with PT/TT;CI value with PT/APTT(P<0.05).In the cerebral hemorrhage group,the R value was positively correlated with PT/APTT;K time with TT;Angle with Fib(P<0.05);R value/K time were negatively correlated with Fib;Angle with TT;CI value with PT(P<0.05).Conclusion For patients with cerebrovascular disease,there is no correlation between TEG indicators and the D-D level of routine coagulation tests;the Angle angle of patients with cerebrovascular disease is positively correlated with the elevated Fib;and MA distance is more useful for diagnosing cerebral infarction than cerebral hemorrhage.TEG is complementary to routine coagulation test,and can be used as a laboratory index for assessing the severity of cerebrovascular disease.