【摘要】 目的 分析血栓弹力图(TEG)参数联合血小板-白细胞聚集体(PLA)检测对急性脑梗死(ACI)患者早期神经功能恶化(END)及预后的预测价值。方法 收集2019年10月至2021年7月我院收治的94例ACI患者。根据发病72 h内NIHSS评分较基线增加≥2分为END组32例，<2分为非END组62例，比较END组与非END组、不同预后患者TEG参数如凝血因子激活时间(RT)、血块形成速率(KT)、凝固角(α-Angle)及弹力图最大振幅((MA)、PLA变化情况。分析TEG参数、PLA与ACI患者病情、预后的相关性。分析TEG参数、PLA单一与联合检测对ACI患者END的预测价值。结果 END组RT、KT值均较非END组短，PLA较非END组高(P<0.05);两组α-Angle及MA值比较差异无统计学意义(P>0.05)。预后良好组KT值较预后不良组高，α-Angle、MA值及PLA较预后不良组低(P<0.05);但两组RT值比较差异无统计学意义(P>0.05)。KT与ACI患者NIHSS、mRS评分均呈负相关，PLA与上述评分呈正相关(P<0.05);α-Angle、MA与ACI患者NIHSS评分无相关性(P>0.05),与mRS评分呈正相关(P<0.05);RT值与NIHSS评分呈负相关(P<0.05),与mRS评分无相关性(P>0.05)。TEG参数、PLA联合检测预测ACI患者END的曲线下面积(AUC)、敏感度、特异度均高于单一检测。结论 TEG参数、PLA检测可有效预测ACI患者END、评估患者预后，联合检测TEG参数、PLA的预测价值更高。更多还原

【Abstract】 Objective To analyze the predictive value of thromboelastogram(TEG) parameters combined with platelet leukocyte aggregate(PLA) detection for early neurological deterioration(END) and prognosis in patients with acute cerebral infarction(ACI).Methods Ninety-four ACI patients admitted to our hospital from October 2019 to July 2021 were collected. According to the NIHSS score within 72 hours of onset, 32 patients who had the increase of NIHSS score ≥ 2 were included in an END group, and 62 patients who had the increase of NIHSS score <2 were included in a non-END group. The TEG parameters of patients with different prognosis, such as reaction time(RT), kinetics of clot development(KT), coagulation angle(α-Angle) and maximum amplitude(MA), and PLA changes were compared between the two groups. The correlation between the TEG parameters and PLA and the ACI patients′ condition and prognosis was analyzed. The predictive value of TEG parameters and PLA with single and combined tests for END in ACI patients was analyzed.Results The RT and KT values were shorter or lower and PLA was higher in the END group than those in the non-END group(P<0.05). There was no significant difference in α-Angle and MA values between the two groups(P>0.05). The KT value was higher, and α-Angle, MA and PLA values were lower in the good prognosis group were lower than those in the poor prognosis group(P<0.05). However, there was no difference in RT value between the two groups(P>0.05). The KT was negatively correlated with the NIHSS and mRS scores of the ACI patients, and PLA was positively correlated with the above scores(P<0.05). α-Angle and MA were not significantly correlated with the NIHSS scores of ACI patients(P>0.05), but positively correlated with the mRS score(P<0.05). RT value was negatively correlated with the NIHSS score(P<0.05), and was not significantly correlated with the mRS score(P>0.05). The area under curve(AUC) of ROC curve analysis, sensitivity, and specificity of TEG parameters combined with PLA for predicting END in ACI patients were higher than those of single test.Conclusion TEG parameters and PLA test can effectively predict the END of ACI patients and evaluate the prognosis of patients. The combined test of TEG parameters with PLA has a higher predictive value.更多还原