摘要
目的 探讨血栓弹力图对急性缺血性卒中静脉溶栓后出血转化(HT)的预测作用。方法回顾性分析2019-01—2021-12南方医科大学附属东莞医院神经内科收治的接受阿替普酶静脉栓治疗的急性脑梗死患者为研究对象,收集入组患者人口统计学、临床数据、血液学指标以及TEG结果,对可能导致急性缺血性卒中患者静脉溶栓后出血转化的相关因素进行单因素及Logistic回归分析。结果 本研究共纳入155例患者,其中31例(20%)溶栓后72 h内经CT/MRI判定为HT,HT组患者的基线NIHSS评分(10.3±4.8 vs.6.8±5.2,P=0.001)、合并心房颤动的比率(35.5%vs 9.7%,P<0.001)均显著高于非HT组患者;HT组患者的血小板数则显著低于非HT组患者[185(164,225.5)vs 224.5(190,263),P=0.009];血栓弹力图各参数的比较中,HT组凝血反应(R值)时间(4.88±1.04 vs 3.95±0.96,P<0.001)和凝固时间(K值)[1.6(1.4,1.9)vs 1.4(1.13,1.68),P=0.003]显著高于非HT组;凝固角(Angle)(67.16±4.28 vs 69.54±5.35,P=0.023)、最大血块强度(MA值)[60.3(57.35,63.8)vs 64.4(60.75,67.8),P=0.005]、凝血系数(CI值)(0.98±0.89 vs 2.22±1.37,P<0.001)则显著低于非HT组。以是否出现出血转化作为应变量,进行2组多因素Logistic回归模型,两个模型均提示基线NIHSS评分是溶栓后出血转化的危险因素(OR 1.195,95%CI1.08~1.323、OR 1.177,95%CI 1.07~1.295,P=0.001),模型1提示凝血反应时间(R值)与溶栓后出血转化发生独立相关(OR 3.368,95%CI 1.817~6.243,P<0.001)(模型1,R2=0.428);模型2提示凝血系数(CI值)与溶栓后出血转化发生呈负相关,(OR 0.374,95%CI 0.243~0.577,P<0.001,R2=0.409)(模型2);受试者工作曲线结果显示,在凝血反应时间R临界值为4.29时,ROC曲线下预测静脉溶栓后出血转化的面积为0.733(P=0.007),其灵敏度为91.7%,特异性为59.4%。在凝血系数CI值临界值为2.05时,ROC曲线下预测静脉溶栓后出血转化的面积为0.757(P<0.001),其灵敏度为51.6%,特异性为88.9%。结论 血栓弹力图的凝血反应时间R值和凝血系数CI值对急性缺血性卒中静脉溶栓后出血转化有早期预测作用。
Objective To investigate the predictive value of thrombelastography for hemorrhage transformation after intravenous thrombolysis in acute ischemic stroke.Methods We reviewed acute ischemic stroke patients consecutively treated with rt-PA from Jan 2019 through Dec 2021.Demographic data,clinical data,hematological indicators,and TEG results were collected,and univariate and logistic regression analyses were performed on the factors that may lead to hemorrhage transformation after intravenous thrombolysis in patients with acute ischemic stroke.Results A total of 155 patients were included in the study.The mean age of the study population was 62.1±12.5 years and 109(70.3%) were male.31(20%) cases developed hemorrhage transformation after intravenous thrombolysis,eventually.In univariate analysis,compared with patients in non-HT group,patients in HT group had higher admission NIHSS score(10.3±4.8 vs 6.8±5.3,P=0.001),higher incidence of artrial afflibration(35.5% vs 9.7%,P<0.001),lower platelet counts [185(164,225.5) vs 224.5(190,263),P=0.009].In TEG test,patients in HT group had longer R time(4.88±1.04 vs 3.95±0.96,P<0.001),longer K value [1.6(1.4,1.9) vs 1.4(1.13,1.68),P=0.003],lower Angle value(67.16±4.28 vs 69.54±5.35,P=0.023),lower MA value [60.3(57.35,63.8) vs 64.4(60.75,67.8),P=0.005] and lower CI value(0.98±0.89 vs 2.22±1.37,P<0.001)than patients in non-HT group.Multivariate Logistic regression analysis models for predicting HT showed that R time and CI value were independent risk factors of HT.The area under the ROC curve for R time value in predicting HT was 0.733,with sensitivity of 91.7% and specificity of 59.4% at the cutoff value of 4.29.The area under the ROC curve for CI value in predicting HT was 0.757,with sensitivity of 51.6% and specificity of 88.9% at the cutoff value of2.05.Conclusions The coagulation reaction time(R value) and coagulation coefficient(CI value) of thrombelastography can predict hemorrhage transformation after intravenous thrombolysis in acute ischemic stroke.
作者
符小丽
郑伟城
李金蕊
柯健霞
石铸
FU Xiaoli;ZHENG Weicheng;LI Jinrui;KE Jianxia;SHI Zhu(Affiliated Dongguan Hospital,Southern Medical Universtiy(Dongguan People’s Hospital),Dongguan 523000,China)
出处
《中国实用神经疾病杂志》
2022年第5期570-576,共7页
Chinese Journal of Practical Nervous Diseases
基金
东莞市社会科技发展项目(编号:201950715001719)。
关键词
缺血性卒中
阿替普酶
静脉溶栓
血栓弹力图
出血转化
Acute ischemia stroke
Recombinant tissue plasminogen activator
Intravenous thrombolysis
Hemorrhage transformation
