血栓弹力图联合凝血功能检测对缺血性脑卒中患者双联抗血小板治疗后复发的评估价值研究

Study on the value of thrombus elastography combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke

目的探讨血栓弹力图(thrombus elastography,TEG)联合凝血功能检测对缺血性脑卒中患者双联抗血小板治疗后复发的评估价值。方法选择接受氯吡格雷和阿司匹林双重抗血小板治疗的缺血性脑卒中患者732例,治疗7 d后采集静脉血进行TEG和常规凝血功能指标检测。6个月时随访,统计缺血性脑卒中复发情况。收集临床资料,分析TEG、凝血功能与缺血性脑卒中患者双联抗血小板治疗后复发的关系以及TEG联合凝血功能指标预测复发的价值。结果随访失联24例,余708例患者中复发226例(复发组),未复发482例(未复发组)。复发组凝血反应时间(coagulation reaction time,R)、血块生成时间(blood clot formation time,K)、国际标准化比值(international normalized ratio,INR)低于未复发组(P<0.05),血细胞凝集块形成速度(rate of hemagglutination formationα,α角)、血凝块最大强度(blood clots maximum intensity,MA值)、凝血综合指数(coagulation index,CI)、纤维蛋白原(fibrinogen,FIB)、D-二聚体高于未复发组(P<0.05)。Logistic逐步回归分析结果显示,糖尿病、高α角、高MA值、高D-二聚体是缺血性脑卒中患者双联抗血小板治疗后复发的危险因素(P<0.05),校正糖尿病后α角(OR=1.411,95%CI:1.006~1.987)、MA值(OR=1.205,95%CI:1.003~1.475)、D-二聚体(OR=1.198,95%CI:0.101~1.387)仍是缺血性脑卒中患者双联抗血小板治疗后复发的危险因素(P<0.05)。受试者工作特征曲线(receiver operating characteristic curve,ROC)结果显示,联合α角、MA值、D-二聚体预测缺血性脑卒中患者双联抗血小板治疗后复发曲线下面积为0.910,高于单独预测的0.720、0.756、0.760(P<0.05)。结论α角、MA值、D-二聚体与缺血性脑卒中患者双联抗血小板治疗后复发有关,并对脑卒中复发有一定预测价值,联合三项指标可提高预测效能。

Objective To explore the value of thrombus elastography(TEG)combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke.Methods A total of 732 patients with ischemic stroke who received clopidogrel and aspirin dual antiplatelet therapy were enrolled.Venous blood was collected at 7 d after treatment for TEG and routine coagulation index detection.The patients were followed up for 6 months,and the recurrence of ischemic stroke during the follow-up period was statistically analyzed.Clinical data were collected to analyze the relationship between TEG,coagulation function and recurrence after dual antiplatelet therapy in patients with ischemic stroke,and the value of TEG combined with coagulation function indexes in predicting recurrence.Results Twenty-four cases were lost to follow-up,and among the remaining 708 cases,226 cases experienced recurrence(recurrence group)and 482 cases did not experience recurrence(non-recurrencegroup).Coagulation reaction time(R),blood clot formation time(K),international normalized ratio(INR)were shorter or lower in recurrence group than in non-recurrence group(P<0.05),Rate of hemagglutination(αangle),maximum intensity of blood clots(MA),blood coagulation index(CI),fibrinogen(FIB),D-dimer(DD)were higher than those in non-recurrence group(P<0.05).Logistic stepwise regression analysis showed that diabetes mellitus,highαangle,high MA value and high D-D were risk factors for recurrence in patients with ischemic stroke after dual antiplatelet therapy(P<0.05).After adjustment for diabetes mellitus,αangle(OR=1.411,95%CI:1.006-1.987),MA(OR=1.205,95%CI:1.003-1.475),D-D(OR=1.198,95%CI:0.101-1.387)were still risk factors for recurrence after dual antiplatelet therapy in patients with ischemic stroke(P<0.05).Receiver operating characteristic curve(ROC)results showed that the area under the ROC curve of combinedαangle,MA value and D-D in predicting the recurrence of patients with ischemic stroke after dual antiplatelet therapy was 0.910,which was higher than 0.720,0.756 and 0.760 of detection alone(P<0.05).Conclusionαangle,MA value and D-D are related to recurrence after dual antiplatelet therapy in patients with ischemic stroke,and have certain predictive value for recurrence of stroke.Combined detection of the three indexes can improve the predictive efficacy.