1.成都中医药大学附属第三医院(西区)脑病科，四川 成都 611730;2.四川省医学科学院·四川省人民医院(电子科技大学附属医院)神经内科，四川 成都 610072
夏敏（1988―），女，主治医师，硕士研究生，主要从事脑血管病及神经变性病的临床和研究工作。Email：396362929@qq.com。
黄国祥（1965―）,男，主任医师，本科，主要从事脑病科的临床和研究工作。Email：2759552554@qq.com。
成都市卫健委2022年医学研究课题（2022231）；成都中医药大学“杏林学者”学科人才科研提升计划医院专项（YYZX2022088）。
1.Department of Encephalopathy， The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West Campus)， Chengdu， Sichuan 611730， China;2.Department of Neurology， Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (Affiliated Hospital of University of Electronic Science and Technology of China)， Chengdu， Sichuan 610072， China
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目的 探讨血栓弹力图（TEG）测得的凝血功能与脑白质病变的相关性。方法 横断面研究连续纳入2022年8月至2023年12月在成都中医药大学附属第三医院（西区）脑病科就诊的急性缺血性脑卒中患者（109例）。按照改良Fazekas量表评分将患者分为4组（0级、1级、2级、3级）。分析比较患者的一般临床资料和TEG指标的组间差异。单因素有序回归分析探讨各因素与高白质信号的相关性，并分别对一般临床资料和一般临床资料联合TEG指标进行逐步双向有序回归分析，筛选不同模型特征量，建立Logistic回归模型。采用受试者操作特征（ROC）曲线、校准曲线和临床决策曲线评估一般临床资料联合TEG指标诊断缺血性脑卒中患者脑白质高信号（改良Fazekas等级≥2级）的价值。结果 4组患者年龄、高血压、卒中史，以及TEG指标最大幅度（MA）、夹角（Angle）和凝血综合指数（CI）的组间比较，差异有统计学意义（P<0.05）。单因素有序回归分析结果显示年龄、高血压、卒中史，以及TEG指标MA、Angle和CI是改良Fazekas等级增高的危险因素（P<0.05）。一般临床资料联合TEG指标模型诊断脑白质高信的ROC曲线下面积和约登指数高于一般临床资料模型。结论 TEG指标MA、Angle和CI与反映缺血性卒中患者的脑白质病变的改良Fazekas等级相关。这对快速评估缺血性脑卒中患者脑白质病变程度有重要指导意义。国际神经病学神经外科学杂志, 2024, 51(4): 16-22]
Objective To investigate the association of coagulation function measured by thromboelastography （TEG） with white matter lesions.Methods A cross-sectional study was conducted among 109 patients with acute ischemic stroke who were consecutively admitted to Department of Encephalopathy， The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine （West Campus）， from August 2022 to December 2023. According to the modified Fazekas scale， the patients were divided into grade 0， 1， 2， and 3 groups， and general clinical data and TEG parameters were compared between groups. A univariate ordinal regression analysis was used to investigate the correlation between various factors and white matter hyperintensity， and a stepwise bidirectional ordinal regression analysis was conducted separately on general clinical data or general clinical data combined with TEG parameters to identify different model features and establish a logistic regression model. The receiver operating characteristic （ROC） curve， calibration curve， and clinical decision curve were used to evaluate the value of general clinical data combined with TEG parameters in the diagnosis of white matter hyperintensity （Fazekas grade≥2） in patients with ischemic stroke.Results There were significant differences among the four groups in age， hypertension， history of stroke， and the TEG parameters of maximum amplitude （MA）， Angle， and coagulation index （CI） （P<0.05）. The univariate ordinal regression analysis showed that age， hypertension， history of stroke， and the TEG parameters of MA， Angle， and CI were risk factors for the increase in modified Fazekas grade （P<0.05）. Compared with the model based on general clinical data， the model based on general clinical data and TEG parameters had a larger area under the ROC curve and a higher Youden index.Conclusions The TEG parameters of MA， Angle， and CI are correlated with the modified Fazekas grade that reflects white matter lesions in patients with ischemic stroke， which has important guiding significance for the rapid diagnosis and evaluation of the extent of white matter lesions. ［Journal of International Neurology and Neurosurgery, 2024, 51(4): 16-22］
引用本文
夏敏,王建力,吴岱宗,高雪飞,龚伟,余能伟,黄国祥456.血栓弹力图与脑白质病变相关性及其诊断价值研究[J].国际神经病学神经外科学杂志,2024,51(4):16-22111XIA Min, WANG Jianli, WU Daizong, GAO Xuefei, GONG Wei, YU Nengwei, HUANG Guoxiang222. Association between thromboelastography and white matter lesions and its diagnostic value[J]. Journal of International Neurology and Neurosurgery,2024,51(4):16-22
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- 收稿日期:2024-01-14
- 最后修改日期:2024-05-09
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- 在线发布日期: 2024-09-27
