血栓弹力图预测急性缺血性卒中出血转化的价值研究

Predictive Value of Thromboelastography for Hemorrhagic Transformation in Acute Ischemic Stroke

背景血栓弹力图(TEG)可以快速评估急诊患者的止血过程,但其能否作为急性缺血性卒中患者发生出血转化的预测工具目前数据有限。目的探究TEG对急性缺血性卒中患者发生出血转化的预测价值。方法选取2018年3月至2020年3月海南医学院第二附属医院卒中中心收治的符合研究标准的2040例急性缺血性卒中患者为研究对象,患者均进行TEG测量,并记录TEG的主要参数(R值,表示凝血反应时间;K值和α角,表示血凝块形成的速率;MA值,表示最大振幅;LY30,表示血凝块的稳定性)。本研究主要观察结果为出血转化,次要观察结果为神经功能恶化。采用Logistic回归分析探究急性缺血性卒中患者发生出血转化的影响因素。结果2040例患者中280例(13.7%)发生出血转化,24例(1.2%)发生神经功能恶化,9例(0.3%)同时出现以上2种情况。多因素Logistic回归分析结果显示:使用双重抗血小板药〔OR=1.335,95%CI(1.100,1.621),P=0.004〕和R值<5.0 min〔OR=1.689,95%CI(1.324,2.153),P<0.001〕是急性缺血性卒中患者发生出血转化的独立影响因素。结论TEG预测急性缺血性卒中患者发生出血转化有一定价值,且TEG中的R值<5.0 min是急性缺血性卒中发生出血转化的危险因素。

Background Thromboelastography(TEG)is a tool that can be used for rapidly assessing hemostasis in emergency patients,but there are few data regarding its predictive value for hemorrhagic transformation in acute ischemic stroke.Objective To examine the predictive value of TEG for hemorrhagic transformation in acute ischemic stroke.Methods Eligible participants harboring an acute ischemic stroke(n=2040)were recruited from Stoke Center,the Second Affiliated Hospital of Hainan Medical University during March 2018 to March 2020.TEG was performed in all cases,and major parameters〔including R(reaction time),K(kinetics),αangle(slope of line between R and K),MA(maximum amplitude),LY30(amplitude at 30 minutes)〕were recorded.The primary endpoint was hemorrhagic transformation.The secondary endpoint was deterioration of neurological function.Logistic regression analysis was used to identify factors associated with hemorrhagic transformation in acute ischemic stroke.Results Among the participants,hemorrhagic transformation occurred in 280 cases(13.7%),neurological deterioration occurred in 24 cases(1.2%),and both conditions were found in 9 cases(0.3%).Multivariate Logistic regression analysis revealed that the use of dual antiplatelet drugs〔OR=1.335,95%CI(1.100,1.621),P=0.004〕and R value<5.0 min〔OR=1.689,95%CI(1.324,2.153),P<0.001〕were independently associated with hemorrhagic transformation in acute ischemic stroke.Conclusion TEG may have some value in predicting hemorrhagic transformation in acute ischemic stroke.The R<5.0 min may be a risk factor indicating hemorrhagic transformation.