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目的探讨血栓弹力图(TEG)在急性缺血性脑卒中双抗治疗中对疗效评估的监测价值。方法选取2011年6月至2016年6月秦皇岛市第一医院急性缺血性脑卒中患者70例为研究对象,所有患者均接受氯吡格雷+阿司匹林双抗治疗,根据治疗结束后1月疗效情况分为预后优良组(n=38)和不良组(n=32),分析两组年龄、性别、治疗1周时神经功能缺损评分(NIHSS评分)、凝血指标及TEG相关指标[凝血反应时间(R)、血细胞凝集块形成时间(K)、血栓最大振幅(MA)、α角]差异,并进行多因素分析,观察TEG指标与NIHSS评分的相关性,并将其纳入ROC曲线模型观察其预测双抗治疗后疗效的可行性。结果治疗1 d时R和K水平较治疗前显著升高,MA较治疗前显著降低,差异有统计学意义(P<0.05)。多因素分析结果显示NIHSS评分、R及MA是影响患者预后的独立因素,差异有统计学意义(P<0.05)。TEG指标R和K与NIHSS评分呈显著负相关性(r=-0.965 9、-0.831 9),MA和α角与NIHSS评分呈显著正相关性(r=0.799 3、0.954 7),差异均有统计学意义(P<0.05)。ROC分析显示治疗1周时R和MA预测患者预后的曲线下面积分别为0.851和0.869。结论急性缺血性脑卒中患者双抗治疗后早期监测血栓弹力图有助于判断患者预后,为临床治疗提供依据。
Objective To investigate the value of thrombus elastography (TEG) in assessing curative effect in double-anti-ischemic stroke patients with acute ischemic stroke. Methods Seventy patients with acute ischemic stroke in the First Hospital of Qinhuangdao from June 2011 to June 2016 were enrolled in this study. All patients were treated with clopidogrel + aspirin. According to the therapeutic effect in January after the end of treatment Two groups were divided into excellent prognosis group (n = 38) and poor group (n = 32). The age, gender, neurological deficit score (NIHSS score), coagulation index and TEG related index [clotting reaction time (K), maximal amplitude of thrombus (MA), α-angle], and analyzed by multivariate analysis. The correlation between TEG index and NIHSS score was observed and included into the ROC curve model to observe its prediction Feasibility of efficacy after double-antibody treatment. Results The level of R and K in the first day of treatment was significantly higher than that before treatment, and the MA was significantly lower than that before treatment, the difference was statistically significant (P <0.05). Multivariate analysis showed that NIHSS score, R and MA were independent prognostic factors in patients with significant difference (P <0.05). There was a significant negative correlation between TEG index R and K and NIHSS score (r = -0.965 9, -0.831 9), positive correlation between MA and αHSI score and NIHSS score (r = 0.799 3, 0.954 7) Statistical significance (P <0.05). ROC analysis showed that the area under the curve of R and MA predictive prognosis was 0.851 and 0.869 respectively at 1 week of treatment. Conclusion The monitoring of thromboelastography in early stage of acute ischemic stroke patients after double-antibody treatment can help to judge the prognosis of patients and provide the basis for clinical treatment.