血浆TAFI和血清Hcy、FIB、D-D联合检测对急性脑出血患者术后再出血的诊断价值分析

Analysis of the Diagnostic Value of Combined Detection of Plasma TAFI and Serum Hcy,FIB and D-D in Patients with Acute Cerebral Hemorrhage

目的探讨血浆凝血酶激活的纤溶抑制物(TAFI)和血清同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、D-二聚体(D-D)联合检测对急性脑出血患者术后再出血的诊断价值。方法方便选取2019年1月—2020年3月经外科手术治疗的急性脑出血患者68例为研究对象。术前患者均取静脉血进行血浆TAFI水平、血清Hcy、FIB、D-D水平以及凝血酶原时间(PT)及国际标准化比值(INR)和血小板计数(PLT)等凝血功能指标水平的检测。患者治疗出院后均随访至少6个月,统计术后住院期间和随访期间再出血发生状况。根据再出血发生情况,将患者分为再出血组(n=27)和对照组(n=41)。结果急性脑出血患者术后再出血发生率为39.71%(27/68)。再出血组血浆TAFI水平和PLT均低于对照组,血清Hcy、FIB、D-D水平、PT和INR则均高于对照组,差异有统计学意义(P<0.05)。Pearson线性相关分析患者血浆TAFI水平、血清Hcy、FIB、D-D水平与PLT、PT和INR等凝血功能指标均密切相关(P<0.05)。多因素Logistic回归分析结果显示,血浆TAFI水平是急性脑出血患者术后再出血的保护因素,而血清Hcy、FIB、D-D水平是急性脑出血患者术后再出血的危险因素[OR(95%CI)=9.723(5.571~13.625)、3.441(2.120~7.956)、4.371(2.326~7.853)、3.136(2.055~6.378),P<0.05]。ROC曲线分析结果显示,血浆TAFI和血清Hcy、FIB、D-D联合检测诊断急性脑出血患者术后再出血的敏感度和准确性均较高。结论血浆TAFI和血清Hcy、FIB、D-D联合检测对急性脑出血患者术后再出血的诊断效能良好,可作为急性脑出血患者术后再出血早期评估参考指标。

Objective To explore the diagnostic value of postoperative rebleeding of the combined detection of plasma thrombin-activated fibrinolytic inhibitor(TAFI),serum homocysteine(Hcy),fibrinogen(FIB),and D-dimer(D-D)in patients with acute cerebral hemorrhage.Methods A total of 68 patients with acute cerebral hemorrhage who were surgically treated from January 2019 to March 2020 were conveniently selected as the research objects.Before surgery,venous blood was taken for the detection of plasma TAFI levels,serum Hcy,FIB,D-D levels,prothrombin time(PT),international normalized ratio(INR)and platelet count(PLT)and other coagulation function indicators.The patients were followed up for at least 6 months after treatment and discharge,and the incidence of rebleeding during the postoperative hospitalization and follow-up period was counted.According to the occurrence of rebleeding,patients were divided into rebleeding group(n=27)and control group(n=41).Results The incidence of postoperative rebleeding in patients with acute cerebral hemorrhage was 39.71%(27/68).The levels of plasma TAFI and PLT in the rebleeding group were lower than those in the control group,while the levels of serum Hcy,FIB,D-D,PT and INR were higher than those in the control group,the difference was statistically significant(P<0.05).Pearson linear correlation analysis of patients'plasma TAFI levels,serum Hcy,FIB,D-D levels and PLT,PT,INR and other blood coagulation function indicators were closely related(P<0.05).Multivariate logistic regression analysis showed that plasma TAFI level was a protective factor for rebleeding after acute cerebral hemorrhage,while serum Hcy,FIB,and DD levels were risk factors for rebleeding after acute cerebral hemorrhage[OR(95%CI)=9.723(5.571-13.625),3.441(2.120-7.956),4.371(2.326-7.853),3.136(2.055-6.378),P<0.05].ROC curve analysis results showed that the sensitivity and accuracy of combined detection of plasma TAFI and serum Hcy,FIB,D-D in diagnosing rebleeding after acute cerebral hemorrhage were high.Conclusion The combined detection of plasma TAFI and serum Hcy,FIB,and D-D has a good diagnostic efficiency for postoperative rebleeding in patients with acute cerebral hemorrhage,and can be used as a reference index for early evaluation of postoperative rebleeding in acute cerebral hemorrhage.