作者：臧立会，任爱兵，贾沛哲，戴芳，王英，解旭东

单位：

071000 河北省保定市，中国人民解放军陆军第八十二集团军医院神经内科 通信作者：臧立会，E-mail：zanglihui88263@163.com

单位（英文）：

Department of Neurology, PLA Army 82nd Group Army Hospital, Baoding 071000, China Corresponding author: ZANG Lihui, E-mail: zanglihui88263@163.com

关键词：

脑梗死; 血栓弹力图; 颈动脉狭窄程度; 血管性事件; 预测;

关键词（英文）：

Brain infarction; Thromboela-stogram; Degree of carotid artery stenosis; Vascular events; Forecasting

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.117

基金项目：

保定市科学技术局科研计划项目（2041ZF338）

摘要：

目的 探讨脑梗死患者血栓弹力图（TEG）参数与颈动脉狭窄程度的关系及其对血管性事件的预测效能。方法 选取2019年1月至2021年1月中国人民解放军陆军第八十二集团军医院收治的脑梗死患者165例作为观察组，根据颈动脉狭窄程度将其分为轻度亚组（颈动脉内径狭窄率≤50%,n=46）、中度亚组（颈动脉内径狭窄率为51%～70%,n=76）和重度亚组（颈动脉内径狭窄率为71%～99%,n=43）；另选取同期于本院体检的健康者100例作为对照组。所有研究对象进行TEG参数（R值、K值、α角、MA值、CI值）检测。采用Spearman秩相关分析探讨脑梗死患者TEG参数与颈动脉狭窄程度的相关性。采用多因素Logistic回归分析探讨脑梗死患者TEG参数与血管性事件的关系。绘制ROC曲线以评估TEG参数对脑梗死患者发生血管性事件的预测效能；采用Delong检验比较AUC。结果观察组R值、K值短于对照组，α角、MA值、CI值大于对照组（P<0.05）。中度亚组、重度亚组R值、K值短于轻度亚组，α角、MA值、CI值大于轻度亚组（P<0.05）；重度亚组R值、K值短于中度亚组，α角、MA值、CI值大于中度亚组（P<0.05）。Spearman秩相关分析结果显示，脑梗死患者R值、K值与颈动脉狭窄程度呈负相关（rs值分别为-0.264、-0.251,P值分别为0.016、0.018）,α角、MA值、CI值与颈动脉狭窄程度呈正相关（rs值分别为0.232、0.245、0.198,P值分别为0.026、0.024、<0.001）。多因素Logistic回归分析结果显示，R值、K值是脑梗死患者发生血管性事件的独立影响因素（P<0.05）。ROC曲线分析结果显示，R值联合K值预测脑梗死患者发生血管性事件的AUC为0.912，大于R值（AUC=0.681）、K值（AUC=0.642）单独预测脑梗死患者发生血管性事件的AUC(Z值分别为2.912、3.324,P值均<0.001)。结论 脑梗死患者TEG参数与颈动脉狭窄程度存在较强的相关性，其中R值联合K值预测脑梗死患者发生血管性事件的效能较好，值得推广应用。

英文摘要：

【Abstract】 Objective To investigate the relationship between thromboela-stogram (TEG) parameters and degree ofcarotid artery stenosis in patients with cerebral infarction and its prediction efficiency for vascular events. Methods A total of165 patients with cerebral infarction admitted to PLA Army 82nd Group Army Hospital from January 2019 to January 2021 wereselected as the observation group. According to the degree of carotid artery stenosis, patients were divided into mild subgroup(carotid artery stenosis ≤ 50%, n=46) , moderate subgroup (carotid artery stenosis 51%-70%, n=76) and severe subgroup (carotidartery stenosis 71%-99% , n=43) . Another 100 healthy people who received physical examination in the same hospital duringthe same period were selected as the control group. All subjects were tested for TEG parameters (R value, K value, α angle, MAvalue, CI value) . Spearman rank correlation analysis was used to analyze the correlation between TEG parameters and degreeof carotid artery stenosis in patients with cerebral infarction. Multivariate Logistic regression analysis was used to analyze therelationship between TEG parameters and vascular events in patients with cerebral infarction. The ROC curve was drawn toevaluate the prediction efficiency of TEG parameters for vascular events in patients with cerebral infarction; and the Delong testwas used to compare the AUC.Results The R and K values in the observation group were shorter than those in the control group,and theα angle, MA and CI values were higher than those in the control group (P < 0.05) . The R value and K value in moderateand severe subgroups were shorter than those in mild subgroup, and theα angle, MA value and CI value were higher than thosein mild subgroup (P < 0.05) . The R value and K value of the severe subgroup were shorter than those of the moderate subgroup,and theα angle, MA value and CI value were higher than those of the moderate subgroup (P < 0.05) . Spearman rank correlationanalysis results showed that R value and K value were negatively correlated with the degree of carotid artery stenosis in patientswith cerebral infarction (rs values were -0.264, -0.251, P values were 0.016, 0.018, respectively) ; the α angle, MA value andCI value were positively correlated with the degree of carotid artery stenosis (rs values were 0.232, 0.245, 0.198, P values were0.026, 0.024, < 0.001, respectively) . Multivariate Logistic regression analysis showed that R value and K value were independentinfluencing factors of vascular events in patients with cerebral infarction (P < 0.05) . ROC curve analysis showed that the AUCof R value combined with K value for predicting vascular events in cerebral infarction patients was 0.912, which was greaterthan that of R value (AUC=0.681) and K value (AUC=0.642) alone for predicting vascular events in cerebral infarction patients(Zvalues were 2.912 and 3.324, respectively, P values were both < 0.001) . Conclusion There is a strong correlation betweenTEG parameters and the degree of carotid artery stenosis in patients with cerebral infarction. Among them, the R value combinedwith the K value has a good efficiency in predicting the occurrence of vascular events in patients with cerebral infarction, which isworthy of popularization and application.

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