血栓弹力图参数预测脑出血患者血肿增大

摘要

目的 探讨血栓弹力图(thrombelastography,TEG)参数对脑出血后血肿增大的预测价值.方法 前瞻性纳入2016年3月至2018年3月期间在发病6h内入住常熟市第二人民医院的原发性脑出血患者.血肿增大定义为发病后48 h内复查CT检测的血肿体积较入院时增加＞12.5 cm3或＞33％.比较血肿增大和非血肿增大组的基线资料,应用多变量logistic回归分析确定TEG参数与血肿增大的独立相关性.采用受试者工作特征(receiver operating characteristic,ROC)曲线分析TEG参数对血肿增大的预测价值.结果 总共纳入141例脑出血患者,其中38例(27.0％)发生血肿增大.与非血肿增大组相比,血肿增大组患者基线美国国立卫生研究院卒中量表评分(P=0.001)、凝血酶时间(P=0.022)、空腹血糖(P=0.007)、血肿破入脑室(P=0.001)、基线血肿体积(P=0.001)以及TEG检测的凝血反应时间(P=0.002)均显著升高,而基线格拉斯哥昏迷量表评分(P=0.001)和TEG检测的α角(P=0.021)均显著下降.多变量logistic回归分析显示,校正混杂因素后,凝血反应时间延长[优势比(odds ratio,OR)3.436,95％可信区间(confidence interval,CI)1.083～9.905;P=0.036]及α角减小(OR 0.777,95％ CI 0.656～0.921;P =0.004)是脑出血后血肿增大的独立预测因素.ROC曲线分析显示,凝血反应时间预测血肿增大的曲线下面积为0.680(95％ CI 0.588～0.772;P=0.004),取4.0 min为截断值时的敏感性为84.2％,特异性为52.4％.α角预测血肿增大的曲线下面积为0.636(95％ CI0.534～0.738;P=0.007),取65.1°为截断值时的敏感性为73.7％,特异性为57.3％.结论 TEG检测的凝血反应时间延长和α角减小对脑出血后血肿增大具有一定的预测价值.%Objective To investigate the predictive value of thromboelastography (TEG) parameters for hematoma enlargement after intracerebral hemorrhage.Methods Patients with primary intracerebral hemorrhage within 6 h after onset admitted to the Second People's Hospital of Changshu between March 2016 and March 2018 were enrolled prospectively.Hematoma enlargement was defined as the volume of hematoma detected by CT within 48 h after onset increased by ＞ 12.5 cm3 or ＞ 33％ compared with that at admission.The baseline data in the hematoma enlargement group and the non-hematoma enlargement group were compared.Multiple logistic regression analysis was used to determine the independent correlation between TEG parameters and hematoma enlargement.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of TEG parameters for hematoma enlargement.Results A total of 141 patients with intracerebral hemorrhage were enrolled,of which 38 (27.0％) had hematoma enlargement.Compared with the non-hematoma enlargement group,the baseline National Institutes of Health Stroke Scale score (P =0.001),thrombin time (P =0.022),fasting blood glucose (P =0.007),hematoma ruptured into the ventricle (P =0.001),baseline hematoma volume (P =0.001),and coagulation reaction time measured by TEG (P=0.002) were significantly increased in the hematoma enlargement group,while the baseline Glasgow Coma Scale score (P =0.001) and α angle measured by TEG (P =0.021) were significantly decreased.Multivariate logistic regression analysis showed that after adjusting confounding factors,the prolonged coagulation reaction time (odds ratio [OR] 3.436,95％ confidence interval [CI] 1.083-9.905;P =0.036) and decreased α angle (OR 0.777,95％ CI0.656-0.921;P =0.004) were the independent predictors of hematoma enlargement after intracerebral hemorrhage.The area under the curve of coagulation reaction time predicting hematoma enlargement was 0.680 (95％ CI 0.588-0.772;P =0.004),and the sensitivity and specificity were 84.2％ and 52.4％ when 4.0 min was the cut-off value.The area under the curve of α angle predicting hematoma enlargement was 0.636 (95％ CI 0.534-0.738;P =0.007).The sensitivity and specificity were 73.7％ and 57.3％ when the cut-off value was 65.1 °.Conclusion The prolonged coagulation reaction time and the decrease of α angle detected by TEG had certain predictive value for hematoma enlargement after cerebral hemorrhage.