血栓弹力图预测冠状动脉粥样硬化风险的效果研究

Research on Predictive Effect of Thromboela-Stogram in Risk of Coronary Atherosclerosis

目的 探讨血栓弹力图(thromboela-stogram,TEG)对冠状动脉粥样硬化疾病的风险预测价值。方法 选取我院心内科诊断为急性冠脉综合征的72位患者,根据是否发生临床不良事件分为不良心血管事件(major adverse cardiovascular events,MACE)组(n=30)和无MACE组(n=36),分析两组TEG指标,采用Cox比例风险模型分析不良事件和TEG参数的关系,采用ROC曲线,计算TEG参数评估冠心病患者出现临床终点事件的ROC曲线下面积最大时的特异性及敏感度。结果 MACE组凝血反应时间(R)值和血细胞凝集块形成时间(K)明显低于无MACE组(均p﹤0.05),无MACE组最大振幅(MA)值和血细胞凝集块形成速率(Angel角)明显低于MACE组(均p﹤0.05)。Cox比例风险模型显示TEG参数MA是影响冠心病患者接受抗血小板治疗后临床不良事件的独立危险因素(p﹤0.05)。ROC曲线下面积为0.815(95%CI:0.675~0.891,p=0.042),最佳界值是46.6mm,敏感度为76.5%,特异性是82.3%。结论 血栓弹力图可为冠状动脉粥样硬化性疾病提供临床用药指导,减少不良心血管事件的发生。

Objective To explore the predictive value of thromboela-stogram(TEG) for coronary atherosclerosis disease.Methods A total of 72 patients diagnosed as acute coronary syndrome in the cardiology department of our hospital were included and divided into major adverse cardiovascular events(MACE) group(n=30) and non-MACE group(n=36).TEG indicators of the two groups were analyzed.Cox proportional hazard model was used to analyze the relationship between adverse events and TEG parameters.TEG parameters were used to evaluate the specificity and sensitivity when the area under the ROC curve for the clinical endpoint events of patients with coronary heart disease was the largest.Results The coagulation reaction time(R) value and the time of clot formation(K) in the MACE group were significantly lower than those in the non-MACE group(p<0.05).The maximum amplitude(MA) value and the clot formation rate(Angel angle) of the non-MACE group were significantly lower than those in the MACE group(p<0.05).The Cox proportional hazard model showed that the TEG parameter MA was an independent risk factor of the adverse events of patients with coronary heart disease after receiving antiplatelet therapy(p<0.05).The area under the ROC curve was 0.815(95% CI:0.675 ~ 0.891,p=0.042),the best cutoff value was 46.6mm,the sensitivity was 76.5%,and the specificity was 82.3%.Conclusion TEG can provide clinical medication guidance for coronary atherosclerosis disease and reduce the incidence of adverse cardiovascular events.