血栓弹力图凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及预测复发缺血事件中的价值

发布时间：2017-12-27 17:42

本文关键词：血栓弹力图凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及预测复发缺血事件中的价值　出处：《中国卒中杂志》2016年03期 　论文类型：期刊论文

【摘要】：目的探讨血栓弹力图(thrombelastography,TEG)凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及进一步预测复发缺血事件中的价值。方法连续纳入符合入选标准的在首都医科大学附属北京天坛医院脑血管病中心住院治疗的急性缺血性脑血管病患者。在阿司匹林联合氯吡格雷双重抗血小板治疗5 d后进行TEG检测。根据TEG检测的血小板抑制率,分为正常血小板反应组和高血小板反应组。比较两组患者TEG凝血酶原通道检测指标的差异。采用多因素Logistic回归分析高血小板反应性的独立相关因素。随访患者出院后3个月、6个月的复发性缺血事件,分析TEG凝血酶原通道检测指标与复发缺血事件的相关性。结果研究共纳入374例患者,与正常血小板反应性组(287例)患者相比,高血小板反应性组(87例)患者血凝块成形时间水平低(P=0.047),血凝块形成速率(P=0.026)、最大振幅水平高(P=0.007)。多因素Logistic回归分析表明:既往缺血性卒中或短暂性脑缺血发作(transient ischemic attack,TIA)病史(OR 1.723,95%CI 1.037~2.863,P=0.036)、血凝块形成速率(OR 1.090,95%CI 1.008~1.180,P=0.032)与高血小板反应性独立相关。共有355例患者完成6个月随访,其中有47例发生复发缺血事件,复发缺血事件组(47例)与无复发缺血事件组(308例)相比,在凝血反应时间、血凝块成形时间、血凝块形成速率、最大振幅方面均无显著差异。结论 TEG凝血酶原通道检测指标有助于评价急性缺血性脑血管病患者高血小板反应性,但在预测复发缺血事件方面的价值尚需进一步研究。
[Abstract]:Objective to evaluate the value of thrombelastography (TEG) prothrombin channel in evaluating the high platelet reactivity and predicting recurrent ischemic events in patients with acute ischemic cerebrovascular disease. Methods the patients with acute ischemic cerebrovascular disease were enrolled in the cerebrovascular disease center of Beijing Tiantan Hospital affiliated to Capital Medical University. TEG was performed after 5 d of aspirin combined with clopidogrel antiplatelet therapy. According to the platelet inhibition rate detected by TEG, it was divided into the normal platelet reaction group and the high platelet reaction group. The differences in the detection of TEG prothrombin channel in the two groups were compared. Multiple factor Logistic regression was used to analyze the independent factors of high platelet reactivity. The recurrent ischemic events of 3 months and 6 months after discharge were followed up, and the correlation between the TEG prothrombin channel detection index and the recurrent ischemic events was analyzed. Results a total of 374 patients were enrolled. Compared with the normal platelet reactive group (287 cases), the blood clotting time was low (P=0.047), the blood clot formation rate (P=0.026) and the maximum amplitude level were high (P=0.007) in the high platelet reactive group (87 cases). Multivariate Logistic regression analysis showed that: the history of ischemic stroke or transient ischemic attack (transient ischemic attack TIA (OR) 1.723,95%CI 1.037~2.863, P=0.036 History), the rate of blood clot formation (OR 1.090,95%CI, 1.008~1.180, P=0.032) and high platelet reactivity independently. A total of 355 patients completed 6 months of follow-up, including 47 cases of recurrent ischemic events, recurrent ischemic events group (47 cases) and non recurrent ischemic events group (308 cases) than in blood coagulation time, blood clot forming time, blood clot formation rate, the maximum amplitude had no significant difference. Conclusion TEG prothrombin channel detection index is helpful for evaluating high platelet reactivity in patients with acute ischemic cerebrovascular disease, but the value of prediction of recurrent ischemic events needs further study.
【作者单位】：华北理工大学附属唐山工人医院神经内科;首都医科大学附属北京天坛医院神经病学中心;唐山职业技术学院信息工程系;
【分类号】：R743.3
【正文快照】： 缺血性卒中(ischemic stroke,IS)或短暂性脑缺血发作(transient ischemic attack,TIA)患者正常服用抗血小板药物的基础上,仍然再发缺血性卒中,称为抗血小板治疗失败,或者称为抗血小板抵抗、抗血小板无反应性,这是广义的定义。狭义的抗血小板抵抗,是指实验室抵抗,在试管内加入

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