Clinical Study Of Using Thrombelastogram To Detect Coagulation And Platelet Function In Patients With Acute Cerebral Infarction

Background and objectiveCerebral vascular disease(vascular disease) is a kind of disease can cause brain dysfunction. In a broad sense, cerebral vascular disease, including cerebral embolism and cerebral thrombosis, which could result in vascular occlusion of the lumen, the rupture of a blood vessel, vessel wall injury or permeability change, and blood viscosity increased or composition of blood abnormal variations and so on. Stroke means neurological impairment caused by acute cerebral local blood circulation disorder, and triggers the corresponding clinical syndrome, duration of symptoms for at least 24 hours. Stroke can cause focal signs and symptoms consistent with the involvement of the cerebral vascular blood supply area. Stroke including transient ischemic attack(TIA), cerebral infarction. Arterothrombotic cerebral infarction is the most common type of cerebral infarction. The most common pathogens is atherosclerosis. Formation of cerebral arterial thrombosis is the most common pathogens of atherosclerotic thrombotic cerebral infarction, plaque rupture form ulcer, collagen is exposed, promotes the formation of blood clots that usually occurs in vascular endothelial injury or flow vortex generating parts, which are the main causes of arterial thrombosis. At present, the clinical commonly used ultrasound screening of carotid and intracranial artery to evaluate atherosclerotic plaque, nature, size and location, clinicians choose the appropriate interventions for treatment. In addition, platelet activate and then adhere and aggregate injury arterial wall is the basis of arterial thrombosis. How to detect platelet function is one of the comparative neglect inspection items for nerve physicians of neurological department during the clinical work. Previously a large number of literature reported, It has achieved certain results that cardiovascular physicians in the treatment of patients with acute myocardial infarction(ACI) after percutaneous coronary intervention therapy(PCI) and detect their platelet function and evaluate antiplatelet aggregation drug efficacy. There are many platelet function testing methods, for example, the ratio of turbidity method, impedance method and so on. The disadvantages of traditional methods in detection process such as causing blood component damage and influenced by hyperlipidemia, detection after cleaning electrode, making it difficult to meet the needs of clinical work. At present, the clinical commonly used thrombelastogram as an indicator to reflect platelet function, especially the function of platelet aggregation. The study using thromboelastography measurement method to evaluate coagulation and platelet function in patients with acute cerebral infarction. To compare the further clinical value of the thromboelastography with the routine coagulation test and the nerve function defect in the patients with acute cerebral infarction and to observe the correlation between them. Therefore, using thromboelastography to guide clinical treatment and intervention measures. MethodsThis study selected 50 cases of patients with acute cerebral infarction within 4-72 hours, as the experimental group, 10 healthy adults served as control group. Underwent Thrombelastogram, blood coagulation and blood cell count were examined before treatment and evaluate the patients by NIHSS score. Thromboelastography values were obtained including K value(coagulation time), R(coagulation reaction time), MA(maximum clot strength) in patients as well as their PT, APTT, fibrin original(FIB), NIHSS core values. The value of K and PT, APTT, R and NIHSS score and FIB, MA, were using Pearson correlation analysis respectively to analysis the relation coefficient and obtained correlation index r. Linear regression analysis of influencing factors of MA value, MA value can evaluate the prediction of cerebral infarction by ROC curve. P<0.05 has statistical significance. Application of SPSS22.0 software for statistical data processing, and use Excel to do the map. ResultsThere was no correlation between K and PT in the experimental group and the control group, and the r was-0.004 and 0.205 respectively, and there was no statistical significance(P > 0.05). There was no correlation between K and APTT in the experimental group and the control group, and the r were 0.275 and 0.238, respectively, and there was no statistical significance(P>0.05). The experimental group and the control group R and FIB were negatively correlated, the r value is-0.189 and-0.221, and there was statistical significance(P < 0.05). The correlation index between experimental groups of MA and NIHSS score was 0.133, there was no statistical significance(P>0.05), regression analysis was not found that NIHSS score is the influence factor of MA, under the ROC curve area of 0.876, 95CI% 0.788,0.964, P<0.05. when the MA value equal to 56.7, MA value prediction sensitivity of cerebral infarction is 0.78, the specificity was 0.9. Conclusion1. In patients with acute cerebral infarction K value stabilizes with APTT, PT changes, suggested that K value in thromboelastography can not reflect the changes of APTT、PT in patients with acute cerebral infarction.2. In patients with acute cerebral infarction R value changes with FIB, suggested that R value in thromboelastography can better reflect the high blood coagulation change.3. In patients with acute cerebral infarction MA value stabilizes with NIHSS score changes, that is, it does not reflect the severity of disease in patients with acute cerebral infarction, but MA value in thromboelastography can reflect platelet aggregation function in patients with acute cerebral infarction, and can predict occurrence of cerebral infarction.