探讨血栓弹力图在急性脑血管病患者中的变化及临床意义

Clinical Value of Thromboelastography in Acute Cerebrovascular Disease Patients

【目的】探讨血栓弹力图(TEG)在急性脑血管病患者中的变化及临床意义。【方法】选择本院神经内科收治的急性脑血管病患者共146例,其中急性脑出血及急性脑梗死患者各73例,所有患者入院后均完善颅脑CT检查,评估脑出血量或脑梗死面积;抽取静脉血检测TEG指标凝血反应时间(R)、凝血形成时间(K)、α角、最大振幅(MA)及凝血综合指数(CI)的水平,比较两组患者TEG指标的差异,分析TEG相关指标与脑出血量及脑梗死面积的关系。应用受试者工作特征(ROC)曲线评估TEG鉴别两种急性脑血管病变的临床价值。【结果】(1)脑出血组患者K时间及R时间均高于脑梗死组,但α角及CI水平小于脑梗死组(P<0.01)。(2)与脑出血≤30 mL的患者相比,脑出血>30 mL的患者K时间缩短,但MA及α角增大(P<0.01)。与小中面积脑梗死患者相比,大面积脑梗死患者R时间缩短,但MA及α角增大(P<0.01)。(3)ROC曲线发现K时间、R时间、α角及CI诊断脑出血的价值曲线下面积(AUC)(95%CI)分别为0.73(0.60〜0.81)、0.82(0.75〜0.89)、0.76(0.68〜0.84)及0.65(0.60〜0.74),且差异均具有统计学意义(P<0.01)。【结论】TEG在急性脑出血及急性脑梗死中的水平相比较具有显著差异,可作为鉴别两种疾病的指标,同时TEG与急性脑血管病病情有相关性。

【Objective】To explore the changes and clinical value of thromboelastography in acute cerebrovascular disease patients.【Methods】A total of 146 patients with acute cerebrovascular disease(73 patients with acute cerebral hemorrhage and 73 patients with acute cerebral infarction)treated in our hospital were collected in this study.All of them received CT scanning after admission to evaluate the volume of cerebral hemorrhage and area of cerebral infarction.Venous bloods were collected to detect level of TEG[coagulation reaction time(R),blood formation time(K),angle,maximum amplitude(MA)and coagulation index(CI)]to compare the difference between two groups and analyze the relationship of TEG indexes with the amount of cerebral hemorrhage and area of cerebral infarction.Meanwhile,the value of TEG to distinguish the two types of acute cerebrovascular disease was identified by using receiver operating characteristic(ROC)curve.【Results】(1)the K time and R time of the cerebral hemorrhage group were higher than those of the cerebral infarction group,while angle and CI levels were lower than those in the cerebral infarction group(P<0.01).(2)Compared to cerebral hemorrhage 30 mL,patients with cerebral hemorrhage 30 mL had shorter K time,while they had higher value of MA and angle;Compared to patients with small and medium-sized cerebral infarction,patients with large-area cerebral infarction had lower R time and higher value of MA and angle(P<0.01).(3)The ROC curve found that the value of K-time,R-time,angle and CI for diagnosis of cerebral hemorrhage were 0.73(0.64-0.81),0.82(0.75-0.89),0.76(0.68-0.84)and 0.65(0.60-0.74),respectively;and all p values were less than 0.05.【Conclusion】The level of TEG in a-cute cerebral hemorrhage and acute cerebral infarction was significantly different.It can be used as an index to identify a-cute cerebral hemorrhage and infarction,which had a relationship with the status of acute cerebrovascular disease.