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。 Objective To investigate the value of detection of thrombin channel in thrombelastography (TEG) in the assessment of platelet reactivity and further prediction of recurrent ischemic events in patients with acute ischemic cerebrovascular disease. Methods The patients with acute ischemic cerebrovascular disease hospitalized in the Cerebrovascular Disease Center of Beijing Tiantan Hospital, Capital Medical University, were included in the study. TEG was performed after aspirin plus clopidogrel dual antiplatelet therapy for 5 days. According to TEG detection of platelet inhibition rate, divided into normal platelet reaction group and high platelet reaction group. The differences of TEG prothrombin channel between the two groups were compared. Multivariate logistic regression was used to analyze the independent association of platelet reactivity. Patients were followed up for 3 months and 6 months after the onset of recurrent ischemic events, analysis of TEG prothrombin channel markers and relapse of ischemic events. Results A total of 374 patients were enrolled in this study. Compared with patients with normal platelet reactivity (n = 287), the patients with high platelet reactivity (n = 87) had lower clotting time (p = 0.047), clot formation rate (P = 0.026), the maximum amplitude was high (P = 0.007). Multivariate logistic regression analysis showed that the past history of ischemic stroke or transient ischemic attack (OR 1.723, 95% CI 1.037-2.863, P = 0.036), the rate of blood clot formation (OR 1.090, 95% CI 1.008-1.180, P = 0.032) were independently associated with high platelet reactivity. A total of 355 patients completed 6 months of follow-up, of which 47 patients had recurrent ischemic events. Compared with 308 patients with recurrent ischemic events (n = 47), there was no significant difference in coagulation time, There was no significant difference in block forming time, clot formation rate and maximum amplitude. Conclusion TEG prothrombin time can be used to evaluate the platelet reactivity in patients with acute ischemic cerebrovascular disease. However, the value of TEG prothrombin time in prediction of recurrent ischemic events needs further study.