脑梗死与脑出血患者的血栓弹力图结果比较及其临床意义

doi:10.6040/j.issn.1671-7554.0.2019.432

摘要/Abstract

摘要： 目的探讨脑梗死与脑出血患者血栓弹力图检测指标的变化以及与传统凝血功能检测结果的相关性。方法选择2018年3月至2019年3月山东大学第二医院收治的73例脑梗死病例和46例脑出血病例作为研究对象,同期在我院体检的健康人群20例作为健康对照组,检测血栓弹力图(TEG)的5项主要指标:凝血反应时间(R值)、凝血形成时间(K值)、血凝块形成速率或α角(Angle)、血栓最大幅度(MA)、凝血综合指数(CI)和传统凝血功能指标:凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原浓度(FIB)、D二聚体(D-Dimer)以及血小板数量(PLT)。结果 3组的K值、Angle、MA值、CI的结果差异有统计学意义,R值无明显差异;脑出血组的Angle、MA值、CI均低于健康对照组,而脑梗死组患者的Angle、MA值、CI均高于健康对照组,脑出血组的K值高于脑梗死组(P<0.05);脑出血组的PLT低于脑梗死组(P<0.05);凝血功能检测结果显示,脑出血组的APTT低于脑梗死组,PT、D-Dimer 高于脑梗死组,差异均具有统计学意义,而两组的FIB、TT无明显差异;血栓弹力图的R值与APTT,K值与PT,Angle、MA和CI与FIB、PLT均呈正相关;而K与FIB、PLT,MA与PT、TT,CI与PT、APTT均呈负相关(P<0.05)。结论脑梗死与脑出血在急性发病期凝血状态复杂,传统凝血功能检测存在片面性和不及时性,而采用血栓弹力图可以更加直观、准确地反映患者真实的凝血状态,以指导临床提高诊治效率。

关键词: 脑梗死, 脑出血, 凝血功能, 血栓弹力图, 输血治疗

Abstract: Objective To investigate the changes of thromboelastogram(TEG)indicators in patients with cerebral infarction and cerebral hemorrhage, and the correlation with the results of traditional coagulation tests. Methods A total of 73 cases of cerebral infarction and 46 cases of cerebral hemorrhage admitted during March 2018 and March 2019 were selected as the research subjects, and 20 healthy people who received physical examination in our hospital during the same period served as healthy controls. The main indicators of TEG and traditional coagulation function indicators were detected, including coagulation reaction time(R value), coagulation formation time(K value), blood clot formation rate or α angle(Angle), maximum thrombus amplitude(MA), coagulation index(CI), prothrombin time(PT), activated partial prothrombin time(APTT), thrombin time(TT), fibrinogen concentration(FIB), D-Dimer, and platelet counts. Results There were significant differences in the values of K, Angle, MA and CI among the 3 groups(P<0.05)while no significant difference in the R value. The Angle, MA and CI values of the hemorrhage group were lower 山东大学学报 (医学版)57卷12期 -李春凤,等.脑梗死与脑出血患者的血栓弹力图结果比较及其临床意义 \=-than those of control group, and the Angle, MA and CI value of the infarction group were higher than those of the controls. The K value of hemorrhage group was higher than that of infarction group, while the platelet count(PLT)was lower(both P<0.05). The APTT in the hemorrhage group was lower than that in the infarction group, while PT and D-Dimer were higher(all P<0.05). There were no significant differences in FIB and TT between the two groups. There were positive correlations between R and APTT, between K, PT and Angle, between MA, CI, FIB and PLT, while there were negative correlation between K and FIB, between PLT, MA and PT, between TT, CI, PT and APTT(all P<0.05). Conclusion Cerebral infarction and cerebral hemorrhage are complicated in the acute onset stage. The traditional coagulation function test is one-sided and untimely. TEG can reflect the true coagulation status more intuitively and accurately, so as to improve the diagnosis and treatment efficiency.

Key words: Cerebral infarction, Cerebral hemorrhage, Coagulation, Thromboelastogram, Blood transfusion therapy

中图分类号:

R446.1

李春凤,李静,赵学英,朱玉芳,亓颖芝,邱霞,张敏,周中民,郎晓艳,芦鑫. 脑梗死与脑出血患者的血栓弹力图结果比较及其临床意义[J]. 山东大学学报 (医学版), 2019, 57(12): 80-85.

LI Chunfeng, LI Jing, ZHAO Xueying, ZHU Yufang, QI Yingzhi, QIU Xia, ZHANG Min, ZHOU Zhongmin, LANG Xiaoyan, LU Xin. Comparison and clinical significance of thrombelastogram in patients with cerebral infarction or cerebral hemorrhage[J]. Journal of Shandong University (Health Sciences), 2019, 57(12): 80-85.

参考文献

[1] Zheng YK, Dong XQ, Du Q, et al. Comparison of plasma copeptin and multiple biomarkers for assessing prognosis of patients with aneurysmal subarachnoid hemorrhage [J]. Clin Chim Acta, 2017, 11(475): 64-69.
[2] 孔顺利, 赵珊珊, 马艳红. CT血管造影在神经内科急性脑血管病诊断中研究[J]. 中外医疗, 2018, 37(11): 160-161, 175. KONG Shunli, ZHAO Shanshan, MA Yanhong. Research on CT angiography in the diagnosis of acute cerebrovascular disease in the department of neurology [J]. China & Foreign Medical Treatment, 2018, 37(11): 160-161, 175.
[3] 陈加平, 徐令奇, 谭彩萍, 等. 血浆和肽素水平与急性脑梗死患者病情及近期预后的关系分析[J]. 临床和实验医学杂志, 2019, 18(5): 489-492. CHEN Jiaping, XU Lingqi, TAN Caiping, et al. Relationship among plasma copeptin,acute cerebral infarction and short-term prognosis [J]. Journal of Clinical and Experimental Medicine, 2019, 18(5): 489-492.
[4] 王文辉. 急性脑梗死病人血清同型半胱氨酸、血脂变化与预后的关系[J]. 世界最新医学信息文摘, 2019, 19(19): 158-159. WANG Wenhui. Relationship between serum homocysteine, serum lipid and prognosis in patients with acute cerebral infarction [J]. World Latest Medicine Information(Electronic Version), 2019, 19(19): 158-159.
[5] 张亮, 王振奎, 张丽, 等. 急性脑梗死与脑出血患者MRI影像学特征及其诊断价值分析[J]. 中国CT和MRI杂志, 2018, 16(11): 5-7, 17. ZHANG Liang, WANG Zhenkui, ZHANG Li, et al. MRI findings of acute cerebral hemorrhage and cerebral infarction and their diagnostic value [J]. Chinese Journal of CT and MRI, 2018, 16(11): 5-7, 17.
[6] Sun L, Zhou W, Mueller C, et al. Oxygen therapy reduces secondary hemorrhage after thrombolysis in thromboembolic cerebral ischemia [J]. J Cereb Blood Flow Metab, 2010, 30(9): 1651-1660.
[7] 田薇. 老年性高血压治疗和脑血管疾病的预防措施分析[J]. 中国医药指南, 2017, 15(23): 81-82.
[8] Liu Z, Chai E, Chen H, et al. Comparison of thrombelastography(TEG)in patients with acute cerebral hemorrhage and cerebral infarction [J]. Med Sci Monit, 2018, 15(24): 6466-6471.
[9] Zhou H, Chen L, He H, et al. Intraoperative and postoperative effects of TEG-guided platelet transfusion on antiplatelet drug-related intracerebral hemorrhage patients [J]. Exp Ther Med, 2019, 17(3): 2263-2267.
[10] Liu H, Li J, Yu J, et al. Research into the predictive effect of TEG in the changes of coagulation functions of the patients with traumatic brain hemorrhage [J]. Open Med(Wars), 2015, 10(1): 399-404.
[11] Wu Z, Liu Z, Zhang W, et al. Risk of anticoagulation therapy in surgical intensive care unit patients predicted by thromboelastograph [J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2018, 30(7): 658-661.
[12] Wen XH, Zhang JH, Gui R. Relation of thromboelastography with coagulation function and Plt count in different coagulation states [J]. Zhongguo Shi Yan Xue Ye Xue Za Zhi, 2018, 26(6): 1793-1799.
[13] 尹晓刚. 脑梗死与脑出血患者血栓弹力实验指标变化的研究[J]. 中国实用神经疾病杂志, 2017, 20(2): 31-34.
[14] 沈蓉, 周华, 孙逸琼, 等. 脑梗死和脑出血患者凝血和血小板状态的研究[J]. 世界最新医学信息文摘, 2018, 18(100): 171-172.
[15] 朱明慧, 王辉, 徐艳, 等. 脑出血、脑梗死急性发作期患者血压、血脂、凝血纤溶功能差异及意义[J]. 山东医药, 2017, 57(4): 66-68.
[16] 曹敏, 张军. 血栓弹力图的临床应用新进展[J].国际检验医学杂志, 2019, 40(2): 246-249. CAO Min, ZHANG Jun. Thromboelastography: clinical applications and new development [J]. International Journal of Laborafory Medicine, 2019, 40(2): 246-249.
[17] 叶文娟. 纤维蛋白原、血小板聚集功能、血栓弹力图联合检测在急性脑梗死患者凝血监测中的临床意义[J]. 中外医学研究, 2016, 14(28): 66-67.
[18] Shimbo D, Abumiya T, Kurisu K, et al. Superior microvascular perfusion of infused liposome-encapsulated hemoglobin prior to reductions in infarctions after transient focal cerebral ischemia [J]. J Stroke Cerebrovasc Dis, 2017, 26(12): 2994-3003.
[19] Bang O, Chung J, Ryoo S, et al. Brain microangiopathy and macroangiopathy share common risk factors and biomarkers [J]. Atherosclerosis, 2016, 246: 71-77. doi: 10.1016/j.atherosclerosis. 2015. 12. 040.
[20] Kleinschnitz C, Braeuninger S, Pham M, et al. Blocking of platelets or intrinsic coagulation pathway-driven thrombosis does not prevent cerebral infarctions induced by photothrombosis [J]. Stroke, 2008, 39(4): 1262-1268.
[21] 郝攀. Hcy、NT-proBNP、D-dimer联合检测对急性脑梗死诊断的应用价值[J]. 标记免疫分析与临床, 2019, 26(2): 212-215, 233. HAO Pan. The diagnostic value of the combined examination of Hcy, NTP ro BNP And D-dimer in patients with acute cerebral infarction [J]. Labeled Immunoassays & Clin Med, 2019, 26(2): 212-215, 233.
[22] Gross PL, Aird WC. The endothelium and thrombosis [J]. Semin Thromb Hemost, 2000, 26(5): 463-478.
[23] Lyden PD, Zivin JA, Clark WA, et al. Tissue plasminogen activator-mediated thrombolysis of cerebral emboli and its effect on hemorrhagic infarction in rabbits [J]. Neurology, 1989, 39(5): 703-708.
[24] 秦祥德, 杨春云, 张媛, 等. 2型糖尿病合并下肢骨折患者凝血分子标志物的变化及其与血栓形成的关系[J]. 山东大学学报(医学版), 2015, 53(11): 55-58, 63. QIN Xiangde, YANG Chunyun, ZHANG Yuan, et al. Changes of thrombosis molecular markers and their clinical values in type 2 diabetic patients with low extremity fractures [J]. Journal of Shandong University(Health Sciences), 2015, 53(11): 55-58, 63.
[25] 梅炳银, 舒志刚, 张阳, 等. 急性进展性脑梗死患者神经功能缺损与血小板参数变化的关系[J]. 血栓与止血学, 2016, 22(4): 412-414. MEI Bingying, SHU Zhigang, ZHANG Yang, et al. The relationship between acute progressive neurologic impairment and platelet parameters changes in patients with cerebral infarction [J]. Chinese Journal of Thrombosis and Hemostasis, 2016, 22(4): 412-414.
[26] Prodan CI, Stoner JA, Dale GL. Lower coated-platelet levels are associated with increased mortality after spontaneous intracerebral hemorrhage [J]. Stroke, 2015, 46(7): 1819-1825.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed