凝血指标联合血栓弹力图指标对缺血性脑卒中患者复发的预测价值研究

Predictive Value of Coagulation Indexes Combined with Thromboelastogram Indexes for Recurrence in Patients with Ischemic Stroke

目的探讨凝血指标联合血栓弹力图(TEG)指标对缺血性脑卒中患者复发的预测价值。方法选取2018年9月至2019年5月新疆医科大学第二附属医院神经内科收治的缺血性脑卒中患者163例,均接受注射用阿替普酶静脉溶栓治疗。收集所有患者的临床资料,包括一般资料、影像学检查结果、实验室检查指标及TEG指标。所有患者自出院开始随访3年,随访截止时间为2022-05-31,根据患者随访期间复发情况将其分为复发组和对照组。采用LASSO回归筛选影响缺血性脑卒中患者复发的变量,采用多因素Logistic回归模型分析缺血性脑卒中患者复发的影响因素,绘制ROC曲线以评估凝血指标、TEG指标及其联合对缺血性脑卒中患者复发的预测价值。结果随访期间,10例患者失访,共153例患者完成随访,其中复发43例,复发率为28.1%。复发组年龄、血栓形成最大幅度(MA值)大于对照组,高血压发生率、心房颤动发生率、总胆固醇高于对照组,凝血酶原时间(PT)、反应时间(R值)、凝固时间(K值)短于对照组,纤维蛋白原(FIB)、D-二聚体(D-D)低于对照组(P<0.05)。采用LASSO回归筛选出影响缺血性脑卒中患者复发的4个变量,分别为FIB、R值、K值、MA值。多因素Logistic回归分析结果显示,FIB升高、R值延长、K值延长是缺血性脑卒中患者复发的保护因素,MA值增大是缺血性脑卒中患者复发的危险因素(P<0.05)。ROC曲线分析结果显示,FIB、R值、K值、MA值预测缺血性脑卒中患者复发的AUC分别为0.758〔95%CI(0.682,0.824)〕、0.762〔95%CI(0.687,0.827)〕、0.947〔95%CI(0.899,0.977)〕、0.800〔95%CI(0.728,0.860)〕,四者联合预测缺血性脑卒中患者复发的AUC为0.988〔95%CI(0.955,0.999)〕。结论FIB升高、R值延长、K值延长是缺血性脑卒中患者复发的保护因素,MA值增大是缺血性脑卒中患者复发的危险因素;FIB、R值、K值、MA值四者联合对缺血性脑卒中患者复发的预测价值较高。

Objective To investigate the predictive value of coagulation indexes combined with thromboelastography(TEG)indexes for recurrence in patients with ischemic stroke.Methods A total of 163 patients with ischemic stroke admitted to the Department of Neurology,the Second Affiliated Hospital of Xinjiang Medical University from September 2018 to May 2019 were selected.All patients received intravenous thrombolysis with artiplase for injection.The clinical data of all patients were collected,including general data,imaging examination results,laboratory examination indexes and TEG indexes.All patients were followed up for 3 years from discharge.The follow-up deadline was 2022-05-31.The patients were divided into recurrence group and control group according to whether recurrence during the follow-up period.LASSO regression was used to screen the variables affecting the recurrence of ischemic stroke patients.Multivariate Logistic regression model was used to analyze the influencing factors of recurrence of ischemic stroke patients.ROC curve was drawn to evaluate the predictive value of coagulation indexes,TEG indexes and the combination of their for recurrence of ischemic stroke patients.Results During the follow-up period,10 patients were lost to follow-up,and 153 patients completed the follow-up,including 43 recurred patients,the recurrence rate was 28.1%.The age and maximum amplitude of thrombosis(MA value)of the recurrent group were older than those of the control group,the incidence of hypertension,the incidence of atrial fibrillation and total cholesterol were higher than those of the control group,the prothrombin time(PT),reaction time(R value)and coagulation time(K value)were shorter than those of the control group,fibrinogen(FIB)and D-dimer(D-D)were lower than those of the control group(P<0.05).Four variables affecting the recurrence of ischemic stroke patients were screened by LASSO regression,namely FIB,R value,K value and MA value.Multivariate Logistic regression analysis results showed that increased FIB,prolonged R value and prolonged K value were protective factors for recurrence of ischemic stroke patients,and increased MA value was a risk factor for recurrence of ischemic stroke patients(P<0.05).The results of ROC curve analysis showed that the AUC of FIB,R value,K value and MA value for predicting the recurrence of ischemic stroke patients was 0.758[95%CI(0.682,0.824)],0.762[95%CI(0.687,0.827)],0.947[95%CI(0.899,0.977)],0.800[95%CI(0.728,0.860)],respectively.The AUC of the combination of FIB,R value,K value and MA value for predicting recurrence of ischemic stroke patients was 0.988[95%CI(0.955,0.999)].Conclusion Increased FIB,prolonged R value and prolonged K value are protective factors for recurrence of ischemic stroke patients,and increased MA value is a risk factor for recurrence of ischemic stroke patients.The combination of FIB,R value,K value and MA value has a higher predictive value for the recurrence of ischemic stroke patients.