Relationship Between R Value And MA Value Of Thrombelastography And Prognosis Of Acute Cerebral Infarction And Carotid Atherosclerosis

ObjectiveTo explore the clinical value of R value and MA value of thromboelastogra m in evaluating the severity,prognosis and carotid atherosclerosis of patients wit h acute cerebral infarction.In order to quickly and accurately judge the coagulat ion state of patients with acute cerebral infarction complicated with carotid ather osclerosis and predict the prognosis of patients,a more accurate laboratory index was found.MethodsTwo hundreds of patients with anterior circulation of acute cerebral infarction hospitalized in the department of neurology of Second Affiliated Hospital of Shenyang Medical College from December 2020 to December 2021 were collected as research objects.The TEG examination was performed within 2 hours of admission,and neurological damage was scored by an experienced clinician according to NIHSS score within 12 hours of admission.The head CT and magnetic resonance examination were performed within 3 days of admission.Carotid artery color Doppler ultrasound was performed within one week after admission,and the carotid atherosclerosis level of patients was measured and recorded by two experienced ultrasound doctors.The general situation of patients including age,sex,past history was recorded with in 7 days.The patients were divided into mild,moderate and severe groups according to NIHSS score and Crouse score of carotid plaque.NIHSS score < 5 is defined as mild,5-15 is defined as moderate,and ≥ 16 is defined as severe.Crouse integral < 5.0 mm is defined as mild,5.1-10.0 mm is defined as moderate,and > 10.0 mm is defined as severe.One-way ANOVA was used to compare the R value and MA value in three groups of patients with acute cerebral infarction with different degrees of neurological deficit and carotid atherosclerosis.Spearman grade correlation was used to analyze the correlation between the R value,MA value of TEG and NIHSS score and Crouse score.The R value and MA value of TEG in patients with acute cerebral infarction with different degrees of neurological deficit and carotid atherosclerosis was measured,and the prognostic factors related to the R value and MA value were analyzed with univariate analysis.Receiver operator characteristic curve（ROC）was used to evaluate the validity of the R value and the MA value in predicting the prognosis of acute cerebral infarction.Results1.The MA value of TEG was positively correlated with the severity of neurological damage and carotid atherosclerosis in the early stage of acute cerebral infarction.The patients who had the more serious the neurological damage and carotid atherosclerosis showed the higher MA value in TEG.MA value is more easily affected by the degree of carotid atherosclerosis than others.2.The R value of TEG was negatively correlated with the severity of neurological injury and carotid atherosclerosis in patients with acute cerebral infarction.The patients who had the more severe the cerebral infarction and the more severe the carotid atherosclerosis showed the lower R value.The R value is more easily affected by neurological damage.3.The R value of TEG was lower,and the MA value was higher in the patients with poor prognosis than that in the patients with good prognosis at 3 months after onset;4.The area under ROC（AUC）in predicting poor prognosis of acute cerebral infarction with the MA value was 0.740（95% CI: 0.647 0.832,P < 0.001）,the sensitivity of 71.4%,and the specificity was 82.7%.The AUC in predicting poor prognosis of acute cerebral infarction with the R value was 0.865（95% CI: 0.798 ~0.931,P < 0.001）,the sensitivity was 71.4%,and the specificity was 91%.The AUC in predicting poor prognosis of acute cerebral infarction with both the R value and the MA value was 0.882（95% CI: 0.821 0.943,P < 0.001）,the sensitivity was 85.7%,the specificity was 78.9%.ConclusionsThe R value,MA value and acute cerebral infarction early neurological damage degree and carotid atherosclerosis degree are closely related;Compared with the good prognosis group,the R value of TEG in the poor prognosis group of cerebral infarction is lower,and the MA value is higher.The R value combined with the MA value of TEG can provide some evidences for predicting the prognosis of cerebral infarction.