摘要
目的探讨动脉粥样硬化性脑梗死患者不同程度的抗血小板聚集治疗以及血栓弹力图(TEG)相关指标对脑微出血的影响。方法选取150例诊断为急性脑梗死并服用阿司匹林的患者进行磁敏感头颅磁共振(SWI)以及TEG检查,并对其进行为期90d的随访。根据与入院时相比脑微出血(CMBs)数量增加是否≥3处以及入院时TEG检测的结果,分为CMBs组和无CMBs组,抗血小板聚集良好组(阿司匹林抑制率>75%)、效果一般组(50%<阿司匹林抑制率≤75%和无效组(阿司匹林抑制率≤50%)。观察各组间CMBs的数目增加与TEG之间的关系,同时对90 d再次发生脑卒中(出血或缺血性卒中)病例数进行对比分析。结果①与无CMBs组比较,CMBs与花生四烯酸(AA)抑制率的增强、未被抑制的血小板活性(MA-AA)的下降以及角度、凝血反应时间(RT)的延长、年龄的增加、糖尿病病例数、高密度脂蛋白(HDL-C)的增高、NIHSS评分的增加、脑白质疏松的程度明显相关,差异有统计学意义(P<0.05)。②将单因素分析筛选出来的相关变量入选到Logistics多因素回归分析,年龄、HDL-C、AA抑制率、MA-AA、RT是CMBs的危险因素(P<0.05)。③良好组与无效组在CMBs、脑卒中事件数、血凝块形成时间(KT)、RT以及MA-AA方面差异均有统计学意义(P<0.05);一般组与无效组在CMBs数量上差异无统计学意义(P>0.05),在脑卒中事件数量以及KT、RT以及MA-AA上差异有统计学意义(P<0.05);良好组与一般组在脑卒中事件数量上差异无统计学意义(P>0.05),在CMBs、RT值以及MA-AA上差异有统计学意义(P<0.05)。结论KT、RT以及MA-AA是反应凝血功能以及抗血小板能力的有效指标。高龄、高HDL-C、AA抑制率过高、MA-AA值较低、RT延长是CMBs的危险因素。在TEG指导下的抗血小板治疗,使阿司匹林抑制率保持在50%~75%之间,在脑梗死的二级预防中更为科学性,同时可减少脑梗死后出血转化以及CMBs,对防止患者远期认知功能下降有指导意义。
Objective To investigate the effect of different degree of antiplatelet aggregation therapy and thromboelastic diagram(TEG)on cerebral microbleeds in patients with atherosclerotic cerebral infarction.Methods A total of 150 patients diagnosed with acute cerebral infarction and given aspirin were examined by magnetic sensitive cranial magnetic resonance(SWI)and TEG and followed up for 90 days.According to whether the number of CMBS increased by>3 and the result of TEG detection compared with on admission,the patients were divided into CMBs and no CMBs group,platelet aggregation in good group(aspirin inhibition rate>75%),the effect of general group(50%<aspirin inhibition rate≤75%)and invalid group(aspirin inhibition rate≤50%).The relationship between increased number of CMBs and TEG was observed in each group,meanwhile,the number of patients with recurrent stroke(bleeding or ischemic stroke)on day 90 was compared and analyzed.Results①CMBs and arachidonic acid(AA)inhibition rate,uninhibited platelet activity(MA-AA),Angle,coagulation reaction time(RT),age,diabetes,high-density lipoprotein(HDL-C),NIHSS score,leubic osteoporosis had statistically significant differences(P<0.05).②The related variables selected from the single factor analysis were selected into the logistic multi-factor regression analysis,and age,HDL-C,AA inhibition rate,MA-AA,RT were risk factors for CMBs(P<0.05).③The difference between the good group and the invalid group was statistically significant in CMBs,number of stroke,KT,RT and MA-AA(P<0.05).There was no significant difference in CMBs between the general group and the invalid group(P>0.05),and there was significant difference in the number of stroke,time of blood clot formation(KT),RT,and MA-AA values(P<0.05).There was no significant difference in the number of stroke between the good group and the general group(P>0.05),but there was significant difference in CMBs,RT value and MA-AA(P<0.05).Conclusion KT,RT and MA-AA are effective indicators of coagulation function and antiplatelet ability.Advanced age,HDL-C,high AA inhibition rate,low MA-AA and prolonged RT are risk factors for CMBs.Antiplatelet therapy under the guidance of TEG keeps the inhibition rate of aspirin between 50%and 75%,which is more scientific in the secondary prevention of cerebral infarction.It is of guiding significance to reduce hemorrhage transformation and CMBs after cerebral infarction and prevent long-term cognitive decline in patients.
作者
周群
徐乔乔
朱幼玲
黄治飞
王昌林
孙中武
Zhou Qun;Xu Qiaoqiao;Zhu Youling(Dept of Neurology,The Third Affiliated Hospital of Anhui Medical Unfersity(The First People's Hospital of Hefei),Hefei 230061)
出处
《安徽医科大学学报》
CAS
北大核心
2020年第8期1241-1245,共5页
Acta Universitatis Medicinalis Anhui
基金
国家自然科学基金项目(编号:81771154)。
关键词
血栓弹力图
脑微出血
脑梗死
磁敏感头颅磁共振
thromboelastic diagram
cerebral microbleeds
cerebral infarction
magnetically sensitive magnetic resonance
