血栓弹力图对急性缺血性脑卒中机械取栓术后出血转化的预测价值

Value of thromboelastogram in evaluation of hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke

目的 探讨血栓弹力图(TEG)在急性缺血性脑卒中(AIS)机械取栓术后出血转化(HT)风险性评估中的临床辅助诊断价值。方法 收集2020-01—2022-09就诊于河南省人民医院神经外科ICU行AIS机械取栓治疗的161例患者的临床资料。根据术后7 d内头颅影像动态检查结果分为HT组36例和非出血转化(NHT)组125例。比较2组患者血清TEG检测相关参数:凝血反应时间(R值)、凝血形成时间(K值)、凝血形成速率(α角)和凝血最终强度(MA)。采用多因素Logistic回归分析AIS取栓术后HT的影响因素,研究TEG各参数对术后发生HT的预测效能和最佳预测阈值。结果 HT组术后第1天TEG参数R值和K值显著高于NHT组,而α角及MA值均显著低于NHT组(P<0.05)。>3次取栓患者的比例、入院ASPECTS、R值、K值、α角及MA值是AIS取栓术后HT的独立影响因素(P<0.05)。ROC分析显示,外周血R值、K值、α角及MA值预测AIS机械取栓术后发生HT的最佳截断值分别为6.5 min、2.3 min、63.7°、58.4mm,曲线下面积(AUC)分别为0.713、0.817、0.726、0.751(P<0.001)。结论 血清TEG检测各参数均与AIS机械取栓术后发生HT存在密切关系,是其独立影响因素,在早期评估HT的发生方面具有较高价值。

Objective To explore the clinical auxiliary diagnosis and application value of thromboelastography(TEG)in the risk assessment of hemorrhagic transformation(HT)after mechanical thrombectomy in acute ischemic stroke(AIS).Methods The clinical data of 161 AIS patients who underwent mechanical thrombectomy in the Neurosurgery ICU of Henan Provincial People's Hospital from January 2020 to September 2022were collected.According to the results of dynamic head imaging within 7 days after operation,patients were divided into hemorrhagic transformation(HT)group(36 cases)and non-hemorrhagic transformation(NHT)group(125 cases).The differences on serum TEG-related parameters(R,K,α angle,MA)between groups were analyzed.The influencing factors of HT after AIS thrombectomy were analyzed by multivariate Logistic regression,and the predictive power and the best predictive threshold of TEG parameters for postoperative HT were studied.Results The R and K values of TEG parameters in the HT group were significantly higher than those in the NHT group on the first postoperative day,while the α angle and MA values were significantly lower than those in the NHT group(P<0.05).The proportion of patients with more than 3 times of thrombectomy,admission ASPECTS,R value,K value,α angle and MA value are independent factors influencing HT after AIS thrombectomy(P<0.05).ROC analysis showed that the best cut-off values for predicting HT of R value,K value,α angle and MA value are 6.5 min,2.3min,63.7°,58.4 mm,respectively,corresponding area under the curve(AUC)were 0.713,0.817,0.726,0.751,respectively(P<0.001).Conclusion The serum TEG related parameters are closely related to the occurrence of HT after mechanical thrombectomy.They are independent risk factors and have high predictive value in the early assessment of HT.