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目的:运用CRUSADE评分系统联合血栓弹力图对急性冠脉综合征(acute coronary syndrome,ACS)患者抗栓治疗中的出血风险进行评估。方法:回顾性分析2013年1月至2013年12月在上海交通大学医学院附属新华医院住院的ACS患者病历249例,用CRUSADE评分联合血栓弹力图评估ACS患者30天出血事件的发生。结果:随访的249例ACS患者,共有46例(18.5%)患者发生了出血事件;按照CRUSADE评分进行危险分层,极低危组、低危组、中危组、高危组、极高危组的出血率分别为:15%、7.5%、21.2%、32.5%26.7%;各组间出血率的比较:中危组、高危组及极高危组各组的出血率均高于低危组,差异有统计学意义;而高危组出血率高于极低危组,差异有统计学意义,而极低危组与其他各组比较,差异无统计学意义;低危组以上患者出血率高于低危组以下,差异有统计学意义。低危组以上中危组、高危组及极高危组各组间出血率比较,差异无统计学意义;按照血小板抑制率中位数分组,大于中位数组的出血率高于小于中位数组,差异有统计学意义。经多因素Logistic分析:PAg T抑制率(ADP)是ACS患者抗栓治疗中出血事件的独立影响因素。利用ROC曲线分析CRUSADE评分、血栓弹力图以及两者联合对患者出血事件发生的评估,两者联合的曲线下面积大于单独利用CRUSADE评分。结论:随着CRUSADE评分危险分层的增加出血的发生率亦呈增加趋势;危险分层低危以上的患者,不论中危、高危、极高危发生出血事件风险较低危险以下有明显增加;血栓弹力图监测血小板抑制率可作为CRUSADE评分的补充,提高对ACS患者出血风险的预测。
OBJECTIVE: To assess the risk of bleeding during antithrombotic therapy in patients with acute coronary syndrome (ACS) using the CRUSADE scoring system in combination with thromboelastography. Methods: A retrospective analysis of 249 ACS patients hospitalized at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2013 to December 2013 was performed. CRUSADE score combined with thromboelastography was used to assess the incidence of 30-day bleeding in patients with ACS. Results: A total of 46 patients (18.5%) were followed up in 249 patients with ACS. Haemorrhagic events occurred in CRUSADE patients. The patients with very low risk group, low risk group, intermediate risk group, high risk group, The hemorrhage rates were 15%, 7.5%, 21.2% and 32.5%, 26.7% respectively. The comparison of hemorrhage rate among different groups showed that the hemorrhage rate in each group was higher than that in low risk group There was statistical significance; while the high-risk group bleeding rate was higher than the extremely low-risk group, the difference was statistically significant, and extremely low-risk group compared with other groups, the difference was not statistically significant; low-risk group of patients with bleeding rate was higher than low At risk group, the difference was statistically significant. There was no significant difference in the bleeding rate between the low-risk group and middle-risk group, the high-risk group and the extremely high-risk group. The hemorrhage rate in the group with the median of platelet inhibition rate was higher than that in the median group, The difference was statistically significant. By multivariate logistic analysis: PAg T inhibition rate (ADP) is an independent factor of bleeding in ACS patients antithrombotic therapy. ROC curve analysis of CRUSADE score, thromboelastometry and the combination of the two in patients with bleeding events, the combined area under the curve greater than the CRUSADE alone score. CONCLUSION: The incidence of hemorrhage increased with the risk stratification of CRUSADE. The risk of hemorrhage was significantly increased in patients with low-risk or above risk, Elastogram monitoring of platelet inhibition rate can be used as a supplement to CRUSADE score to improve the prediction of bleeding risk in patients with ACS.