齐泓竹 刘强

[摘要] 目的 探討血栓弹力图（TEG）与常规凝血试验在急性缺血性卒中（AIS）患者的应用价值。 方法 选取2019年1—12月在我院住院治疗的AIS患者（病例组）100例及同期于我院门诊检查的非卒中患者（对照组）100例，记录AIS患者入院时的国立卫生研究院卒中量表（NIHSS）评分，将其分为轻、中、重度组。收集所有患者的一般临床资料、TEG及常规凝血四项指标，对上述指标进行统计分析。 结果 病例组与对照组患者在吸烟史、糖尿病、高脂血症方面比较，差异有统计学意义（P<0.05）;在TEG参数的比较中，病例组与对照组比较，轻、中、重度组间比较，差异均有统计学意义（P<0.05）;在常规凝血四项指标的比较中，病例组与对照组间差异有统计学意义（P<0.05），轻、中、重度组间差异无统计学意义（P>0.05）;K值、α角、MA值、FIB值与AIS发生事件独立相关;TEG参数α角对AIS具有较高诊断价值（AUC>0.9，P<0.05），MA值具有中等诊断价值（AUC>0.7，P<0.05），常规凝血四项指标FIB值具有中等诊断价值（AUC>0.7，P<0.05）。 结论 AIS患者的TEG参数有明显异常，且在轻、中、重度组中均存在差异，有望作为临床预警指标，成为临床医生指导预防及治疗工作的新工具。

[关键词] 急性缺血性卒中;血栓弹力图;凝血功能;预测

[Abstract] Objective To explore the application value of thromboelastogram（TEG） and routine coagulation test（RCT） in patients with acute ischemic stroke（AIS）. Methods A total of 100 patients（case group） with AIS hospitalized in our hospital from January to December 2019 and 100 non-stroke patients（control group） examined in the outpatient service at the same time were selected. The National institutes of health stroke scale（NIHSS） scores of the patients with AIS at admission were recorded， and the AIS patients were divided into the mild group， the moderate group and the severe group. The general clinical data， TEG and four indexes of RCT of all the patients were collected and analyzed statistically. Results The differences between the patients of the case group and the control group in smoking history， diabetes mellitus and hyperlipidemia were statistically significant（P<0.05）. In the comparison of TEG parameters， the differences between the case group and the control group and the differences among the mild， moderate and severe groups were all statistically significant（P<0.05）. In the comparison of four indexes of RCT， the differences between the case group and the control group were statistically significant（P<0.05）， while the differences among the mild， moderate and severe groups were statistically insignificant（P>0.05）. K value， α angle， MA value and FIB value were independently related to AIS incidence. The α angle of TEG parameters has much higher diagnostic value for AIS（AUC>0.9， P<0.05）， MA value had medium diagnostic value（AUC>0.7， P<0.05）， and the FIB value of indexes of RCT has medium diagnostic value（AUC>0.7， P<0.05）. Conclusion The TEG parameters are obviously abnormal in the patients with AIS， and they vary among the mild， moderate and severe groups， which can be expected to serve as a clinical alert and become a new tool for clinicians to guide prevention and treatment.

[Key words] Acute ischemic stroke; Thromboelastogram; Coagulation function; Prediction

我国流行病学研究结果显示，脑血管疾病的发病率、死亡率、致残率均在逐年增加[1]，已跃居我国第一大死亡原因，其与心血管疾病及恶性肿瘤构成了我国三大死亡主因[2]。而急性缺血性卒中（Acute ischemic stroke，AIS）作为目前最常见的急性脑血管疾病类型[3]，其预防和治疗已成为亟待解决的临床问题。在AIS的预防环节，一级预防显得尤为重要[4]。众所周知，AIS的危险因素包括可干预因素与不可干预因素，可干预因素即各种原因导致的高血压、Ⅰ型及Ⅱ型糖尿病、各种心脏疾患、脂质代谢异常、高同型半胱氨酸血症、长期吸烟、大量饮酒、过度肥胖等[5]。近些年来，有研究显示，上述危险因素最终均会影响机体内的凝血系统[6-7]，通过作用于血管内皮，引起血管内皮损伤及产生相应的活性因子，导致体内凝血与抗凝系统失衡，主要包括血小板激活、凝血机制启动及随之发生的纤维蛋白溶解[8]。但目……