血栓弹力图对比血小板聚集率在轻中度急性缺血性脑卒中患者的抗血小板治疗中的应用

Application of Thrombelastography to Compare Platelet Aggregometry Test in Antiplatelet Therapy in Patients with Mild to Moderate Acute Ischemic Stroke

目的:对比血栓弹力图和血小板聚集率试验两种技术,在轻⁃中度急性缺血性脑卒中的抗血小板治疗前后血液功能变化的监测中的应用,为个性化用药提供理论指导和奠定基础。方法:纳入自2021年6月至2022年7月来揭阳市人民医院神经内科住院并行抗血小板治疗的轻⁃中度急性缺血性脑卒中患者,共47例,并于首诊(入院时)和治疗后(出院时)行血栓弹力图、血小板聚集率和卒中量表的评估。利用配对t检验分析治疗前后的血液功能变化以及相关性分析各检验指标与脑卒中严重度之间的关系;同时采用受试者工作特征(ROC)曲线探索各指标对疾病疗效的预测作用。结果:治疗前后的血栓弹力图的凝血反应时间(R值)、最大振幅(MA值)和凝血综合指数(CL值)存在显著性差异(P<0.05);治疗前的凝血反应时间(R值)(r=-0.352)、凝血综合指数(CL值)(r=0.302)与脑卒中的严重度存在相关性(P<0.05),另外,治疗前的凝血综合指数(CL值)对疾病的疗效有预测作用(AUC=0.701,95%CI:0.527-0.876,P<0.05)。结论:在评价轻⁃中度急性缺血性脑卒中患者抗血小板治疗的血液功能变化上,血栓弹力图要优于血小板聚集率试验,血栓弹力图的R值和CL值在指导个性化用药上有潜在的临床应用价值。

Objective:To investigate the difference of thrombelastography(TEG)and Platelet aggregometry test in evaluating the coagulation function of mild⁃to⁃moderate acute ischemic stroke(AIS)patients before and afterantiplatelet therapy,andproviding the theory instruction forpersonalized medication.Methods:The clinical data of 47 patients with mild⁃to⁃moderate acute ischemic stroke(AIS),admitted to our hospital from June 2021 to July 2022,were included to be analyzed.The TEG,Platelet aggregometry and stroke scale(National Institutes of Health Stroke Scale,NIHSS)were assessed before(admission)and after treatment(discharge).Paired t⁃test was used to analyze the changes in coagula⁃tion function before and after antiplatelet therapy and the correlation analysis performed between TEG,Platelet ag⁃gregometry and stroke diseaseseverity.And the receiver⁃operating characteristic(ROC)curve was used to explore the predictive effect of each index on disease efficacy.Results:There were significant differences in response time of coagu⁃lation(R),maximum amplitude(MA)and composite index(CL)of TEG before and after treatment(P<0.05);the re⁃sponse time of coagulation(R)(r=-0.352)and composite index(CL)(r=0.302)before treatment were correlated with the severity of stroke disease(P<0.05).In addition,the composite index(CL)before treatment predicted the outcome of the disease(AUC=0.701,95%CI:0.527-0.876,P<0.05).Conclusion:TEG was more sensitive and comprehensive than platelet aggregation in evaluating the changes of coagulation function in patients with mild⁃moderate acute ischemic stroke in antiplatelet therapy.Specially,the response time of coagulation(R)andcomposite index(CL)ofTEG has po⁃tentialclinical application value in guiding personalized medicine.