应用血栓弹力图检测血小板抑制率指导急性非心源性卒中抗血小板治疗的研究

Study on the guidance of patelet inhibition rate detected with thrombelastogram in antiplatelet therapy for acute non-cardiogenic stroke

目的探讨应用血栓弹力图(thrombelastogram,TEG)检测血小板抑制率在急性非心源性卒中抗血小板治疗中的应用价值。方法选择2020年9月至2021年10月于四川省宜宾市第四人民医院就诊的缺血性非心源性卒中患者100例为研究对象,采用随机数字表法分为观察组和对照组,每组各50例,观察组在应用抗血小板药物治疗前、治疗1周后取静脉血,应用TEG仪检测花生四烯酸(arachidonic acid,AA)途径和二磷酸腺苷(adenosine diphosphate,ADP)途径诱导的血小板抑制率。观察血小板抑制率变化情况,对出院患者的神经功能缺损情况行美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分,随访3个月时行改良Rankin量表(modified Rankin scale,mRS)评分及卒中复发、出血等事件。结果观察组患者治疗后AA、ADP途径诱导的血小板抑制率均分别显著高于治疗前(P<0.05);治疗后双抗者AA、ADP途径诱导的血小板抑制率均分别高于单抗者(P<0.05);观察组患者出院时的NIHSS评分、随访3个月时mRS评分均分别低于对照组(P<0.05),观察组良好功能结局者达93.62%(44/47),多于对照组的75.56%(34/45),差异有统计学意义(P<0.05);观察组卒中复发率(4.26%)和出血事件发生率(2.13%)均分别低于对照组(20.00%和17.78%),差异有统计学意义(P<0.05)。结论急性非心源性卒中患者应用TEG检测血小板抑制率以指导抗血小板治疗,可降低卒中复发率和出血风险,改善患者临床预后。

Objective To investigate the application value of thrombelastogram(TEG)in detection of platelet inhibition rate for antiplatelet therapy for acute non-cardiogenic stroke.Methods A total of 100 patients with ischemic non-cardiogenic stroke were selected in this study from September 2020 to October 2021 in the Fourth People's Hospital of Yibin.All the patients were divided into observation group and control group,with 50 cases for each group with random number table.Before and after 1 week of treatment with antiplatelet drugs,the platelet inhibition rate in observation group were measured with arachidonic acid(AA)and adenosine diphosphate(ADP)by TEG;No platelet inhibition rates detection was conducted for the control group.The changes in platelet inhibition rate were observed,the neurological deficits of the discharged patients were scored with NIHSS score,mRS score,stroke recurrence,hemorrhage and other events were followed up at the 3^(rd) month of discharge.Results After treatment,the inhibition rates of AA and ADP of the observation group were significantly higher than those before treatment(P<0.05);After treatment,the inhibition rates of AA and ADP in dual antiplatelet patients were higher than those of monoclonal antiplatelet(P<0.05).The NIHSS score at discharge and the mRS score at 3^(rd) month follow-up in the observation group were lower than those in the control group(P<0.05),and there were 93.62%(44/47)of the patients with good functional outcomes in the observation group than those of 75.56%(34/45)in the control group,the difference was statistically significant(P<0.05);The incidences of stroke recurrence was 4.26%and hemorrhage events was 2.13%in the observation group,which were lower than those in the control group,which were 20.00%and 17.78%,the difference was statistically significant(P<0.05).Conclusion The application of thrombelastogram in detection of platelet inhibition rate to guide antiplatelet therapy in patients with acute non-cardiogenic stroke reduces the recurrences of cerebral infarction and the risk of hemorrhage,and improves patients’clinical prognosis.