目的 探讨血栓弹力图(TEG)在评估脑梗死患者长期预后中的价值。 方法 2015年1月至2016年7月，选取神经内科住院首次发病的脑梗死患者255例，入院进行TEG和常规凝血试验(凝血四项和血小板)检测，出院3个月后进行TEG检测，采用门诊就诊或电话联系方式对患者跟踪随访1年。根据脑梗死是否复发，分为预后不良组(n = 51)与预后良好组(n = 204)，比较两组TEG参数和常规凝血检测指标的差异。 结果 两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、糖尿病、高血压病、吸烟、入院美国国立卫生研究院卒中量表(NIHSS)评分和服用抗血小板药物等方面比较无显著性差异(P > 0.05)；两组的凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和血小板(PLT)比较无显著性差异(P > 0.05)。与预后良好组相比，预后不良组入院时凝血反应时间和凝血形成时间缩短，凝块形成速率和最大振幅增加(P < 0.05)；出院3个月后，预后不良组仅最大振幅水平增高(P < 0.05)，而凝血反应时间、凝血形成时间和凝块形成速率无显著性差异(P > 0.05)。 结论 在脑梗死预后不良患者中，TEG参数异常可提示血液存在高凝状态，对判断脑梗死的长期预后有一定临床意义。
Objective To explore the value of thrombelastography in long-term prognosis for patients with cerebral infarction. Methods From January, 2015 to July, 2017, 255 patients with cerebral infarction hospitalized were selected. Thrombelastography and routine coagulation test (four coagulation and platelets) were tested after patients' admission. And thrombelastographic test was performed again 3 months after discharge. The patients were followed up for a year by outpatient visits or telephone contact. According to whether cerebral infarction recurred, they were divided into unfavorable prognosis group (n = 51) and favorable prognosis group (n = 204), and the difference of thrombelastography and routine coagulation test were compared between the two groups. Results There was no statistically significant difference in total cholesterol, triglyceride, low density lipoprotein cholesterol, diabetes, hypertension, smoking, scores of National Institutes of Health Stroke Scale, and administration of antiplatelet drugs between the two groups (P > 0.05); There was no statistically significant difference in thrombin time, prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet in routine coagulation test between the two groups (P > 0.05). Compared to the favorable prognosis group at admission, reaction time and kinetics time of thrombelastographic test shortened significantly, while rate of clot strengthening and maximum amplitude increased significantly in the unfavorable prognosis group (P < 0.05); three months after discharge, only maximum amplitude increased significantly (P < 0.05) while there was no significant difference in reaction time, kinetics time and rate of clot strengthening in the unfavorable prognosis group (P > 0.05). Conclusion Abnormal parameters of thrombelastographic test may indicate hypercoagulability in blood in the patients with cerebral infarction which predicts unfavorablein long-term outcome.
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