| Objective:Thrombelastography(TEG)was first suggested by Harlert from Germany in 1948.It's an auxiliary diagnosis approach for supervision and research of blood coagulation status in patients,and a visualized valuable index for blood coagulation state,which belongs to blood rheology measurements.In early days,it was only used for experimental investigation,but now has already been widely applied to clinical blood transfusion,monitoring and correcting of hypercoagulable state,treatment of traumatic patients,and monitoring clinical efficacy of antiplatelet drugs and so on.TEG can be used to monitor whole blood coagulation,because it has synthesized the effects in the clotting process which are made by such as plasma components(blood coagulation factors,fibrous protein)and cell composition(PLT?RBC?WBC)on coagulation.As one of the mainly hazard for health of human nowadays,the causes of cerebral infarction are associated with a variety of factors,many researches show that the main reason is platelet activation,imbalance of coagulation system and fibrinolytic system.Currently,there are less reports on cerebral vascular disease with TEG monitoring blood coagulation state.In the experiment,we have studied preliminarily on the changes of TEG parameters in the patients with acute cerebral infarction,and the correlation between the parameters and the conventional coagulation indexes.Methods:A total of 122 patients with acute cerebral infarction(within 48h)were selected as objects of study,from Dec.2014 to Nov.2015 in the Hebei Medical University No.2 Hospital,asked and recorded all the patients disease history in detail,divided into men group(46 cases),the women group(76 cases)according to different genders;according to "the Stroke classification and staging treatment proposal draft regulation standard in China in 2000 ",divided into small(102 cases)and large cerebral infarction group(20 cases);according to the pathogenetic condition if shows progression of the disease in 6h onset of ACI,divided all the patients into progressive(42 cases)and nonprogressive cerebral infarction group(80 cases);according to the following points 1)developed new clinical symptom and neurological function defects 2)the original symptoms and signs exacerbated,and more than one month passed since the last time of cerebral infarction 3)new ischemic responsible foci were certified by Head CT or MRI in the above-mentioned conditions,divided all the patients into first-episode group(59 cases)and recurrent group(63 cases),20 cases patients without cerebral infarction were detected simultaneously as controls.All patients were determined by TEG and conventional coagulation tests simultaneously.TEG analyzer(TEG-5000)was used to determine the parameters of R value,K value,angle(?)value and MA value.The conventional coagulation(PT?APTT?Fib?TT)was detected by ACL-TOP automatic blood coagulation analyzer.Results:1 In the conventional coagulation tests results,compared to the control,the PT?APTT?Fib and TT value of acute cerebral infarction group decreased,there was no significant difference(P>0.05),only Fib level significantly increased(3.24±0.62 vs.2.87±0.53,P<0.05);In the TEG parameters test results,compared to the control,the acute cerebral infarction group exhibit significant decreasing R values(6.33±1.63 vs.7.15±1.63,P<0.05),increasing MA value(63.65±5.42 vs.60.82±3.86,P<0.05)and an angle(64.95±4.15 vs.62.96±3.86,P<0.05),but Non-parametric test results showed that P value=0.338,P>0.05,thus there was no significant difference with K value between the two groups;2 In the cerebral infarction patients TEG test results,there was no significant difference between the men group and the women group with the parameters(R?Angle?MA)(P>0.05),except K value(1.77±0.28 vs.1.65±0.26,P<0.05);3 Compared to the first-episode group,the recurrent group exhibit significant decreasing R(5.70±1.42 vs.7.01±1.59(P<0.05)and K values(1.63±0.24 vs.1.83±0.28,P<0.05),and increasing MA value(65.92±4.96 vs.61.23±4.81,P<0.05),using Nonparametric test to test the angle value between the two groups,we obtained the data Z=-4.027,P < 0.05),so the angle value was significantly higher than the first-episode group;4 Compared to the small cerebral infarction group,the large group exhibit significant decreasing R(4.46±0.83 vs.6.70±1.50,P<0.05)and K values(1.49±0.20 vs.1.77±0.27,P<0.05),increasing MA value(69.55±3.94 vs.62.49±4.90,P<0.05)and an angle(67.62±3.36 vs.64.47±4.15,P< 0.05);5 Compared to the non-progressive cerebral infarction group,the progressive group exhibit decreasing R(5.33±1.33 vs.6.86±1.54,P<0.05)and K values(1.58±0.26 vs.1.80±0.26,P<0.05),increasing MA value(65.59±4.87 vs.62.63±5.44,P<0.05)and an angle(67.01±3.99 vs.63.92±3.90,P<0.05),and these were getting more obvious,prompting a hypercoagulable tendency.Conclusion:TEG parameters not only can reflect more fully in the body's blood clotting process,but also have higher sensitivity compared with conventional coagulation.Simultaneously,TEG is helpful for the diagnosis of the disturbance of blood coagulation acute cerebral infarction,evaluate of severity and help clinicians assess disease outcome in the early onset(within 48h),then make early positive intervention on the patients.Besides,TEG can be used to guide the treatment,and confirm the efficacy of individual therapy on patients with acute cerebral infarction,but all of these need large sample clinical researches to be further confirmed. |
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