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

摘要/Abstract

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。

文章导读： 本研究发现血栓弹力图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，但是在预测急性缺血性脑血管病患者复发缺血事件方面尚需进一步研究。

关键词: 血栓弹力图; 急性缺血性脑血管病; 高血小板反应性; 复发缺血事件

Abstract:

Objective To investigate the value of prothrombin channel detection index from the thrombelastography (TEG) in evaluation of the high platelet reactivity (HPR) and further prediction of recurrent ischemic events. Methods In-patients with acute ischemic cerebrovascular disease who were admitted to Center of Neurology, Beijing Tiantan Hospital, Capital Medical University and eligible for inclusion criteria were continuously enrolled into study. TEG was tested after dual antiplatelet therapy with aspirin and clopidogrel for 5 days. According to platelet inhibition rate in TEG at baseline, the patients were divided into the normal platelet reaction (NPR) group and the high platelet reaction (HPR) group. The prothrombin channel detection indexs from the TEG test were compared between thetwo groups. Multivariate Logistic regression analysis was used to analyze independent correlative factor for HPR. The recurrent ischemic events were followed up at month 3 and month 6 after discharge from hospital. The association between prothrombin channel detection index from the TEG and recurrent ischemic events was analyzed. Results A total of 374 patients were recruited in the study. Compared with the NPR group (n =287), the patients with HPR group (n =87) had a lower K level (P =0.047), but a higher Angle levels (P =0.026) and maximum amplitude (MA) (P =0.007). Multivariate logistic regression analysis showed that: previous history of ischemic stroke or transient ischemic attack (TIA) (OR 1.723, 95%CI 1.037-2.863, P =0.036) and Angle level (OR 1.090, 95%CI 1.008-1.180, P =0.032) was independently associated with HPR. There were 355 patients who fulfilled the 6 month follow-up, among which, there were 47 cases of recurrent ischemic events. Comparison was made between recurrent ischemic events group (n =47) and non-recurrent ischemic event group (n =308) , and there were no significant differences in the K, Angle, MA and R levels of the endpoint. Conclusion Prothrombin channel detection index from the TEG is helpful to evaluate the HPR in patients with acute ischemic cerebrovascular disease, but a further study is needed to investigate value for TEG in predicting the recurrent ischemic events.

Key words: Thrombelastography; Acute ischemic cerebrovascular disease; High platelet reaction; Recurrent ischemic event

饶子龙，郑华光，王菲，王安心，刘丽萍，董可辉，曲辉，龚浠平，张倩，赵性泉，陆菁菁，鞠奕，方瑞乐，王文娟，杨中华，温淼，魏娜，濮月华，王伊龙，曹亦宾. 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[J]. 中国卒中杂志, 2016, 11(03): 207-214.

RAO Zi-Long ZHENG Hua-Guang, WANG Fei, et al.. Value of Thrombelastography in Predicting the High Platelet Reactivity and Recurrent Ischemic Events of Patients with Acute Ischemic Cerebrovascular Disease[J]. Chinese Journal of Stroke, 2016, 11(03): 207-214.

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