轻中度急性脑梗死患者血栓弹力图参数与血液高凝状态的关系及对早期神经功能恶化的预测价值

Relationship Between Thromboelastography Parameters and Hypercoagulability and Its Predictive Value in Early Neurological Deterioration in Patients with Mild to Moderate Acute Cerebral Infarction

目的 探讨轻中度急性脑梗死患者血栓弹力图(TEG)参数与血液高凝状态的关系及对早期神经功能恶化的预测价值。方法 选择我院2019年1月—2021年1月收治的136例轻中度急性脑梗死作为观察组,另选同期136例体检健康者作为对照组;比较2组入组24 h TEG参数[反应时间(R时间)、凝血时间(K时间)、α角、血栓最大振幅(MA)、凝血指数(CI)]和血小板聚集率(PAgT)、D-二聚体(D-D)、纤维蛋白原(FIB)水平;观察2组入院3 d内神经功能恶化情况,使用多因素Logistic回归分析寻找轻中度急性脑梗死患者早期神经功能恶化的预测因素,通过受试者工作特征(ROC)曲线评价TEG参数对患者早期神经功能恶化的预测价值。结果 观察组R时间、K时间均短于对照组,α角、MA、CI值均大于对照组,PAgT、D-D、FIB水平均高于对照组(P<0.05,P<0.01);经Pearson相关性分析,轻中度急性脑梗死患者PAgT、D-D、FIB水平与R时间、K时间均呈正相关,与α角、MA、CI值均呈负相关(P<0.05)。多因素Logistic回归分析显示,R时间、K时间是轻中度急性脑梗死患者早期神经功能恶化的独立预测因素(P<0.05,P<0.01);ROC曲线分析显示,R时间联合K时间预测轻中度急性脑梗死患者早期神经功能恶化的曲线下面积为0.905,优于二者单一预测。结论 轻中度急性脑梗死患者TEG参数与血液高凝状态存在较强的相关性,R时间联合K时间对患者早期神经功能恶化有一定的预测价值。

Objective To investigate the relationship between thromboelastography(TEG) parameters and hypercoagulability in patients with mild to moderate acute cerebral infarction(ACI) and its predictive value in early neurological deterioration. Methods In total, 136 cases of mild to moderate ACI treated in our hospital from January 2019 to January 2021 were selected as the observation group, and 136 physical examinees in the same period were selected as the control group. The 24-h TEG parameters [reaction time(R time), coagulation time(K time), α Angle, maximum thrombus amplitude(MA), coagulation index(CI)] and platelet aggregation rate(PAgT), D-Dimer(D-D), fibrinogen(FIB) levels at 24 h after admission were compared between the two groups. The deterioration of neurological function was observed in the two groups within 3 days after admission. Multivariate logistic regression analysis was used to find the predictive factors of early neurological deterioration in patients with mild to moderate ACI, and the predictive value of TEG parameters in early neurological deterioration was evaluated by the receiver operating characteristic(ROC) curve. Results R time and K time in the observation group were shorter than those in the control group, α angle, MA and CI value were higher than those of the control group, and the levels of PAgT, D-D and FIB were higher than those of the control group(P<0.05, P<0.01). According to Pearson correlation analysis, the levels of PAgT, D-D and FIB in patients with mild to moderate ACI were positively correlated with R time and K time and negatively correlated with α Angle, MA and CI value(P<0.05). Multivariate logistic regression analysis showed that R time and K time were independent predictors of early neurological deterioration in patients with mild to moderate ACI(P<0.05, P<0.01). ROC curve analysis showed that the area under the ROC curve of R time combined with K time to predict early neurological deterioration in patients with mild to moderate ACI was 0.905, which was better than the single prediction. Conclusion There is a strong correlation between TEG parameters and blood hypercoagulability in patients with mild to moderate ACI. R time combined with K time in TEG can is of value in predicting the early deterioration of neurological function.