急性脑梗死患者凝血功能与脑血流量的关系

Relationship of coagulation function and cerebral blood flow in patients with acute cerebral infarction

目的探讨急性脑梗死患者凝血功能与脑血流量的关系。方法对53例急性脑梗死患者(脑梗死组)及53例正常对照者(正常对照组)行血栓弹力图(TEG)检查,比较两组的凝血反应时间(R)、凝固时间(K)、凝固角(α)、血栓最大幅度(M)、凝血块强度(G)和纤溶指数(LY30)。采用3D伪连续动脉自旋标记灌注成像(3D-pCASL)评价比较两组患者的局部脑血流量(CBF),并与TEG参数进行相关分析。结果与正常对照组比较,急性脑梗死组R值、K值及CBF显著降低(t=3.75,t=-11.39,t=-18.34;均P<0.05),α值、M值、G值和LY30显著升高(t=3.47,t=8.37,t=4.50,t=2.52;均P<0.05)。急性脑梗死患者R值、K值与CBF呈正相关性(r=0.81,r=0.56;均P<0.05),而α值、M值、G值、LY30与CBF呈负相关(r=-0.28,r=-0.54,r=-0.46,r=-0.34;均P<0.05)。结论TEG异常的急性脑梗死患者同时伴有ASL灌注的异常。无创性的ASL和TEG检查可以互补,能够较为准确的判断急性脑梗死患者的凝血功能异常状况,并为急性脑梗死区范围及血流灌注状况提供预测。

Objective To investigate the relationship of coagulation function and cerebral blood flow in patients with acute cerebral infarction.Methods Fifty-three patients with acute cerebral infarction(cerebral infarction group)and 53 normal controls(normal control group)were examined by thromboelastography(TEG),and the coagulation reaction time(R),coagulation time(K),coagulation angle(α),maximum thrombosis amplitude(M),coagulation strength(G)and fibrinolytic index(LY30)of two groups were compared.The regional cerebral blood flow(CBF)of three-dimensional artery spin-labeled perfusion imaging(3 D-ASL)was compared.Correlation analysis was used to study the relationship between CBF and TEG parameters.Results Compared with those in normal control group,the R,K and CBF in cerebral infarction group were significant decrease(t=3.75,t=-11.39,t=-18.34;all P<0.05),theα,M,G and LY30 in cerebral infarction group were significant increase(t=3.47,t=8.37,t=4.50,t=2.52;all P<0.05).There was a positive correlation between R,K and CBF in cerebral infarction patients(r=0.81,r=0.56;all P<0.05),and there was a negative correlation betweenα,M,G,LY30 and CBF in cerebral infarction patients(r=-0.28,r=-0.54,r=-0.46,r=-0.34;all P<0.05).Conclusion Acute cerebral infarction patients with abnormal TEG accompanied with abnormality ASL perfusion.The complementation of non-invasive ASL and TEG can accurately judge the abnormal coagulation function of patients with acute cerebral infarction,and provide a prediction for the area of acute cerebral infarction and blood perfusion.