血栓弹力图在评价急性缺血性卒中患者凝血功能中的应用研究
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摘要
目的探讨血栓弹力图(TEG)在评价急性缺血性卒中患者凝血功能中的作用。方法选取急性缺血性卒中住院患者与健康体检者各116例作为病例组与健康对照组,比较病例组与健康对照组凝血指标和TEG参数的差异,分析凝血指标与TEG参数之间的关系。结果病例组急性期纤维蛋白原(FIB)、D-二聚体(D-D)、最大血凝块强度(MA)、MA后0.5h血凝块减少速率(LY30)、α角、综合凝血指数(CI)与血凝块强度(G)明显高于健康对照组与病例组恢复期,差异有统计学意义(P<0.01)。病例组急性期活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶原时间-国际标准化比率(PT-INR)、反应时间(R值)、凝血块形成时间(K值)明显低于健康对照组与病例组恢复期,差异有统计学意义(P<0.01)。MA、LY30、α角、CI、G与PT、APTT、PT-INR呈负相关,而与FIB、D-D呈正相关;R值、K值与PT、APTT、PT-INR呈正相关,差异均有统计学意义(P<0.05),而与FIB、D-D呈负相关,差异均有统计学意义(P<0.05)。结论 TEG在监测和评价急性缺血性卒中患者凝血功能中的作用显著,且对疾病转归具有重要的评定作用,值得临床推广应用。
Objective To evaluate the role of thrombus elastograph(TEG)in evaluating the coagulation function of patients with acute ischemic stroke.Methods Totally 116 cases of patients with acute ischemic stroke and 116 cases of health physical examination people from our hospital were selected as case group and control group.The blood clotting index and thrombelastogram index of the groups were detected.Results In case group of acute phase,fibrinogen(FIB),two D-dimer(D-D),maximum blood clot strength(MA),0.5 h blood clot reduction rate of MA(LY30),alpha angle,integrated coagulation index(CI)and blood clot strength(G)were significantly higher than those of control group and the recovery period group.The difference was statistically significant(P<0.01).In cases of acute phase,activated partial thromboplastin time(APTT),prothrombin time(PT),PT-INR,reaction time(R),clot formation time(K value)were significantly lower than those in the healthy control group and the recovery period cases,the difference was statistically significant(P<0.01).MA,LY30,αAngle and CI were negatively correlated with PT,APTT,PT-INR,and were positively correlated with FIB,D-D(P<0.05);R value,K value were positively correlated with PT,APTT,PT-INR,and were negatively correlated with FIB,D-D(P< 0.05).Conclusion TEG plays a significant role in monitoring and evaluating coagulation function in patients with acute ischemic stroke,and has important evaluation effect on the prognosis of disease.It is worthy of clinical application.
Objective To evaluate the role of thrombus elastograph(TEG)in evaluating the coagulation function of patients with acute ischemic stroke.Methods Totally 116 cases of patients with acute ischemic stroke and 116 cases of health physical examination people from our hospital were selected as case group and control group.The blood clotting index and thrombelastogram index of the groups were detected.Results In case group of acute phase,fibrinogen(FIB),two D-dimer(D-D),maximum blood clot strength(MA),0.5 h blood clot reduction rate of MA(LY30),alpha angle,integrated coagulation index(CI)and blood clot strength(G)were significantly higher than those of control group and the recovery period group.The difference was statistically significant(P<0.01).In cases of acute phase,activated partial thromboplastin time(APTT),prothrombin time(PT),PT-INR,reaction time(R),clot formation time(K value)were significantly lower than those in the healthy control group and the recovery period cases,the difference was statistically significant(P<0.01).MA,LY30,αAngle and CI were negatively correlated with PT,APTT,PT-INR,and were positively correlated with FIB,D-D(P<0.05);R value,K value were positively correlated with PT,APTT,PT-INR,and were negatively correlated with FIB,D-D(P< 0.05).Conclusion TEG plays a significant role in monitoring and evaluating coagulation function in patients with acute ischemic stroke,and has important evaluation effect on the prognosis of disease.It is worthy of clinical application.
引文
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[6]王婷玉,上官志敏,韦俐,等.TEG血小板图报告药物抑制率应优先计算普通杯MA结果[J].国际检验医学杂志,2016,37(23):3367-3368.
[7]张嵘,汪青松,黄海滨.颈动脉支架植入术与药物治疗颈动脉狭窄疗效比较[J].安徽医学,2015,36(10):1236-1238.
[8]ZACHO M,RAFIQ S,KELBK H,et al.Hypercoagulability in relation to coronary artery bypass graft patency and clinical outcome[J].Scand Cardiovasc J,2013,47(2):104-108.
[9]TANG F K,LIN L J,HUA N,et al.Earlier application of loading doses of aspirnand clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention[J].Chin Med J(Engl),2012,25(4):631-638.
[10]SAMBU N,CURZEN N.Monitoring the effectiveness of antiplatelet therapy:opportunities and limitations[J].Br J Clin Phamacol,2011,72(4):683-696.
[11]GURBEL P A,BLIDEN K P,NAVICKAS I A,et al.Adenosine diphosphate-induced platelet-fibrin clot strength:a new thrombelastographic indicator of long term poststenting ischemic events[J].Am Heart J,2010,160(2):346-354.
[2]KREUTZ R P,OWENS J,LU D,et al.Platelet factor XIIIa release during platelet aggregation and plasma clot strength measured by thrombelastography in patients with coronary artery disease treated with clopidogrel[J].Platelets,2015,26(4):1-6.
[3]KHANNA V,MIKAEL R,THAYALASAMY K,et al.Does the response to aspirin and clopidogrel vary over 6months in patients with ischemic heart disease[J].J Thromb Haemost,2015,13(6):920-930.
[4]TANG X F,HAN Y L,ZHANG J H,et al.Comparing of light transmittance aggregometry and modified thrombelastograph in predicting clinical outcomes in chinese patients undergoing coronary stenting with clopidogrel[J].Chin Med J(Engl),2015,128(6):774-779.
[5]中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国脑血管疾病分类2015[J].中华神经科杂志,2017,50(3):168-171.
[6]王婷玉,上官志敏,韦俐,等.TEG血小板图报告药物抑制率应优先计算普通杯MA结果[J].国际检验医学杂志,2016,37(23):3367-3368.
[7]张嵘,汪青松,黄海滨.颈动脉支架植入术与药物治疗颈动脉狭窄疗效比较[J].安徽医学,2015,36(10):1236-1238.
[8]ZACHO M,RAFIQ S,KELBK H,et al.Hypercoagulability in relation to coronary artery bypass graft patency and clinical outcome[J].Scand Cardiovasc J,2013,47(2):104-108.
[9]TANG F K,LIN L J,HUA N,et al.Earlier application of loading doses of aspirnand clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention[J].Chin Med J(Engl),2012,25(4):631-638.
[10]SAMBU N,CURZEN N.Monitoring the effectiveness of antiplatelet therapy:opportunities and limitations[J].Br J Clin Phamacol,2011,72(4):683-696.
[11]GURBEL P A,BLIDEN K P,NAVICKAS I A,et al.Adenosine diphosphate-induced platelet-fibrin clot strength:a new thrombelastographic indicator of long term poststenting ischemic events[J].Am Heart J,2010,160(2):346-354.