| Objective: To investigate the difference of thromboelastic diagram(Thromboelastography,TEG)parameters(R value,K value,Angle Angle,MA value)between large-artery atherosclerotic(large-artery atherosclerosis,LAA)ischemic stroke(ischemic Stroke,IS)and small artery occlusive(Small-artery occlusion,SAO)ischemic stroke.And blood clots elastic graph parameters and Fibrinogen coagulation index,Fibrinogen,Fib(Fibrinogen,Fib)and D-dimer(D-dimer,D-D),the relationship between the type for different points of provide evidence for the diagnosis and treatment of ischemic cerebral apoplexy.Methods:From April 2018 to December 2018,224 patients with ischemic stroke who were admitted to the first clinical affiliated hospital for treatment for less than or equal to 72 hours were successively collected.According to the TOAST classification criteria,102 patients with large atherosclerosis and 122 patients with small artery occlusion were divided into two groups according to the medical history,physical examination and related auxiliary examination results.At the same time,62 healthy subjects in the same period were included as the control group,and the parameters of thrombus elastography,fibrinogen,d-dimer and other tests were performed,respectively,for statistical analysis and comparison of the difference in baseline data between the three groups and the correlation between them.Results: 1.There were no statistical differences in age and ethnicity among the three groups;According to the chi-square test results,the ratio of hypertension in the SAO group was high(chi-square value =68.504,P=0.000<0.05).The ratio of diabetes in the SAO group was high(chi-square value =28.536,P=0.000<0.05).Smoking rate was higher in LAA group(chi-square value =51.875,P=0.000<0.05).The ratio of alcohol consumption in LAA group was high(chi-square value =23.473,P=0.000<0.05),and the difference was statistically significant.There was a statistical difference in gender among the three groups(chi-square value =15.483,P < 0.05).2.According to the results of nonparametric rank sum test,there was no statistical difference in R value(P=0.922),Fib(P=0.922)and d-dimer(P=0.135)between males and females.The K value of male was higher than female(1.8767 0.48467 vs1.7350 0.51102,p<0.05).Angle Angle of female is higher than male(64.8192 5.63578 vs.66.6043 6.03842,p<0.05);MA value of female was higher than that of male(59.74384.57241 vs 59.5450 4.16697,p<0.05),and the difference was statistically significant.3.TEG parameters(R value,K value,Angle Angle,MA value),Fib,d-dimer were compared among the three groups.Kruskal Wallis test results showed that the R value in the case group was lower than that in the control group,and the LAA group was lower than that in the SAO group(4.46 0.84 vs.4.9 0.86 vs.5.18 0.94,P<0.05).When K value decreased,LAA group was lower than SAO group(1.6 0.48 vs 1.82 0.44 vs 2.13 0.49,P<0.05).The Angle Angle increased,and the LAA group was higher than the SAO group(67.89 5.96 vs.65.75 5.08 vs.61.95 5.48,P<0.05).When MA value increased,LAA group was higher than SAO group(61.39 4.83vs59.35 3.83 vs 57.4 3.34,P<0.05),and the difference was statistically significant.The level of Fib in the case group was higher than that in the control group,and that in the LAA group was higher than that in the SAO group(3.59 0.83 vs 2.83 0.53 vs 2.65 0.38,P<0.05).When the d-dimer level increased,the LAA group was higher than the SAO group(0.85 1.01 vs.0.410.34 vs.0.28 0.22,P<0.05),and the difference was statistically significant.4.Spearman correlation analysis results showed that R value was positively correlated with K value(rho=0.446,P < 0.05),and negatively correlated with Angle Angle,MA value,Fib,d-dimer(rho =-0.495,-0.139,-0.137,-0.170,P < 0.05).K value had a significant negative correlation with Angle Angle,MA value,Fib,d-dimer(rho =-0.946,-0.682,-0.331,-0.197,P < 0.05).Angle Angle had a significant positive correlation with MA value,Fib,d-dimer(rho 0.593,0.274,0.189,P < 0.05,respectively).MA value had a significant positive correlation with Fib and d-dimer(rho 0.517,0.208,P < 0.05,respectively).Fib was positively correlated with d-dimer(rho =0.392,P < 0.05),and the difference had statistical significance.Conclusion: The expression levels of TEG parameters were different in LAA type and SAO type ischemic stroke.The R value and K value of LAA type ischemic stroke were lower than that of SAO type,and the Angle Angle,MA value,Fib and D-D value were higher than that of SAO type.While TEG parameter value was significantly correlated with conventional coagulation indexes,R value and K value were negatively correlated with Fib and D-D,whileAngle Angle and MA value were positively correlated with Fib and D-D.Therefore,it can be further concluded that TEG may provide a certain reference value in the identification of the two subtypes,and provide a new method and basis for the clinical diagnosis and treatment of stroke patients with different etiological types. |
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