血栓弹力图在初发急性心肌梗死患者中的临床应用

doi:10.3969/j.issn.1004-583X.2021.02.006

摘要/Abstract

摘要：

目的探讨血栓弹力图(thromboelastography, TEG)监测与急性心肌梗死患者的冠状动脉病变严重程度是否相关、与住院期间主要心血管不良事件(major adverse cardiac events, MACE)是否相关。方法选择我院初发急性心肌梗死(acute myocardial infarction,AMI )患者(AMI组)80例,健康体检者(正常对照组)30例。根据心电图表现,将AMI组分为急性ST段抬高型心肌梗死(ST elevated myocardial infarction, STEMI )组49例和非ST段抬高型心肌梗死(non ST elevated myocardial infarction, NSTEMI )组31例,在服用抗血小板药物和做急诊冠状动脉介入治疗术前的2小时内抽血监测血栓弹力图,比较两亚组血栓弹力图与冠状动脉病变程度Gensini评分、MACE的关系。结果 AMI组R值和K值均低于正常对照组,且STEMI组R值和K值低于NSTEMI(P<0.05)。AMI组Angle和MA均高于正常对照组,且STEMI 组Angle、MA值、Gensini评分和MACE发生率高于NSTEMI组(P<0.05)。结论 AMI患者的高凝状态预示着更严重的冠状动脉病变、更高MACE发生率。

关键词: 心肌梗死, 血栓形成, 主要心脏不良事件

Abstract:

Objective To analyze whether thromboelastogram (TEG) monitoring related to the severity of coronary artery pathological changes in patients with acute myocardial infarction ( AMI ) and whether it involved with cardiovascular adverse events in hospital. Methods Eighty patients with primary AMI were selected in our hospital as AMI group, 30 healthy persons served as normal control group. According to electrocardiogram, AMI group was further divided into 49 cases of acute ST-elevated myocardial infarction (STEMI) group and 31 cases of non-ST-elevated myocardial infarction (NSTEMI) group. Thromboelastogram was monitored by blood drawing within 2 hours before taking antiplatelet drugs and undergoing emergency coronary intervention. The relationship between the thromboelastogram and coronary artery pathological changes degree Gensini score and major adverse cardiac events (MACE) were evaluated in two subgroups. Results The R value and K value of AMI patients were lower than those of normal control group. The R value and K value of STEMI group were lower than those of NSTEMI (P<0.05). The Angle and MA value of patients with AMI were higher than those of normal control group, and the angle, MA value, Gensini score and MACE incidence in STEMI group were higher than those in NSTEMI group (P<0.05). Conclusion Hypercoagulability in patients with AMI predicts more severe coronary artery pathological changes and a higher incidence of MACE.

Key words: acute myocardial infarction, thrombosis, major adverse cardiac events

中图分类号:

R541.4

张小乐, 蔡肇栩, 张贺琼, 王洋洋, 陆少云, 杨春万. 血栓弹力图在初发急性心肌梗死患者中的临床应用[J]. 临床荟萃, 2021, 36(2): 125-128.

Zhang Xiaole, Cai Zhaoxu, Zhang Heqiong, Wang Yangyang, Lu Shaoyun, Yang Chunwan. Clinical application of thromboelastogram in patients with primary acute myocardial infarction[J]. Clinical Focus, 2021, 36(2): 125-128.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.02.006

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I2/125

图/表 2

参考文献 20

[1]	Trinh TH, Pao LP, Pivalizza EG. Thrombelastograph platelet mapping during hyperfibrinolysis[J]. J Cardiothorac Vasc Anesth, 2019, S1053-0770(19):31264-1269.
[2]	Pivalizza EG, Melnikov V, Guzman-Reyes S, et al. Thrombelastograph platelet mapping in a patient receiving antiplatelet therapy[J]. Liver Transpl, 2010,16(7):919-920. doi: 10.1002/lt.v16:7 URL
[3]	Thomas JD, Vinh BP, Schulz S, et al. Novel use of hrombelastograph platelet mapping in a patient taking dipyridamole[J]. J Clin Anesth, 2011,23(3):257.
[4]	Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983,51(3):606. pmid: 6823874
[5]	Lansky AJ, Ng VG, Meller S, et al. Impact of nonculprit vessel myocardial perfusion on outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes: analysis from the ACUITY trial(Acute Catheterization and Urgent Intervention Triage Strategy)[J]. JACC Cardiovasc Interv, 2014,7(3):266-275. doi: 10.1016/j.jcin.2013.08.016 URL
[6]	da Luz LT, Nascimento B, Rizoli S. Thrombelastography(TEG): practical considerations on its clinical use in trauma resuscitation[J]. Scand J Trauma Resusc Emerg Med, 2013,21:29. doi: 10.1186/1757-7241-21-29 URL
[7]	Williams DM, Hodge A, Catino J, et al. Correlation of thromboelastography with conventional coagulation testing in elderly trauma patients on pre-existing blood thinning medications[J]. Am J Surg, 2018,216(5):874-880. doi: 10.1016/j.amjsurg.2018.06.017 URL
[8]	Emani S, Sleeper LA, Faraoni D, et al. Thromboelastography is associated with surrogates for bleeding after pediatric cardiac operations[J]. Ann Thorac Surg, 2018,106(3):799-806. doi: 10.1016/j.athoracsur.2018.04.023 URL
[9]	Chi TY, Liu Y, Zhu HM, et al. Thromboelastography-derived parameters for the prediction of acute thromboembolism following non-steroidal anti-inflammatory drug-induced gastrointestinal bleeding:a retrospective study[J]. Exp Ther Med, 2018,16(3):2257-2266.
[10]	Swallow RA, Agarwala RA, Dawkins KD, et al. ThromlxIelastography: potential bedside tool to assess the effects of antiplatelet therapy[J]. Platelets, 2006,17(6):385-392. pmid: 16973499
[11]	Hou X, Han W, Gan Q, et al. Relationship between thromboelastography and long-term ischemic events as gauged by the response to clopidogrel in patients undergoing elective pereutaneous coronary intervention[J]. Biosci Trends, 2017,11(2):209-213. doi: 10.5582/bst.2016.01233 URL
[12]	孔庆瑞, 赵云兰, 林萍, 等. 急性冠状动脉综合征患者血栓弹力图特征及临床意义研究[J]. 国际心血管病杂志, 2019,46(3):179-182.
[13]	蔡秋妍, 凌雨. 血栓弹力图与常规凝血试验在急性心肌梗死患者中的相关性分析[J]. 医学检验与临床, 2019,30(2):66-68.
[14]	陶格斯, 牛瑞兵, 张静. 血栓弹力图检测在急性心肌梗死患者中的应用研究[J]. 当代医学, 2017,23(30):55-57.
[15]	刘嘉莹, 寇威, 王景春, 等. 血栓弹力图预测STEMI的诊断价值: 一项基于ROC曲线的回顾性研究[J]. 中国合理用药探索, 2019,16(1):12-15, 19.
[16]	阚宏亮, 马喆, 张佃花, 等. 血栓弹力图在冠心病患者临床诊断中的应用价值[J]. 解放军预防医学杂志, 2019,37(1):19-21, 35.
[17]	林桂花, 杨晓冬. 血栓弹力图在冠状动脉介入术患者抗血小板效果、心脏不良事件评估中的应用[J]. 血栓与止血学, 2019,25(2):199-201, 204.
[18]	金慧, 乌日娜. 早期心型脂肪酸结合蛋白与血栓弹力图联合检测对急性心肌梗死预后的评估价值[J]. 中国医刊, 2020,55(2):155-158.
[19]	Dridi NP, Lønborg JT, Radu MD, et al. Hypercoagulation assessed by thromboelastography is neither related to infarct size nor to clinical outcome after primary percutaneous coronary intervention[J]. Clin Appl Thromb Hemost, 2014,20(8):825-831. doi: 10.1177/1076029613485411 URL
[20]	郭云飞, 吴永健, 肖文琦, 等. 氯吡格雷抵抗患者应用替格瑞洛临床疗效[J]. 临床荟萃, 2015,30(1):1-5.

组别	例数	男性 [例(%)]	年龄 (岁)	高血压 [例(%)]	糖尿病 [例(%)]	LDL-C (mmol/L)	吸烟 [例(%)]
对照组	30	19(63.3)	56.90±10.59	8(26.7)	6(20.0)	3.00±0.72	16(53.3)
AMI组	80	46(57.4)	61.21±10.14	34(42.5)	21(26.3)	3.00±0.72	43(52.8)
STEMI组	49	28(57.1)	60.65±11.20	22(44.9)	13(26.5)	3.35±1.03	26(53.7)
NSTEMI组	31	18(54.8)	62.10±8.27	22(38.7)	8(25.8)	3.46±1.03	17(54.8)
统计值		χ²=0.361	F=2.103	χ²=2.942	χ²=1.005	F=2.314	χ²=7.403
P值		0.948	0.127	0.401	0.800	0.104	0.060

组别	例数	男性 [例(%)]	年龄 (岁)	高血压 [例(%)]	糖尿病 [例(%)]	LDL-C (mmol/L)	吸烟 [例(%)]
对照组	30	19(63.3)	56.90±10.59	8(26.7)	6(20.0)	3.00±0.72	16(53.3)
AMI组	80	46(57.4)	61.21±10.14	34(42.5)	21(26.3)	3.00±0.72	43(52.8)
STEMI组	49	28(57.1)	60.65±11.20	22(44.9)	13(26.5)	3.35±1.03	26(53.7)
NSTEMI组	31	18(54.8)	62.10±8.27	22(38.7)	8(25.8)	3.46±1.03	17(54.8)
统计值		χ²=0.361	F=2.103	χ²=2.942	χ²=1.005	F=2.314	χ²=7.403
P值		0.948	0.127	0.401	0.800	0.104	0.060

组别	例数	R (min)	K (min)	Angle (°)	MA (mm)	Gensini评分 (分)	MACE [例(%)]
对照组	30	7.37±1.01	2.05±0.43	56.93±7.09	54.70±6.09	-	-
AMI组	80	6.29±1.26^**	1.83±0.37^*	61.23±6.19^**	58.06±7.19^**	69.00±23.1^##	10(12.5)^#
STEMI组	49	5.72±1.02^**	1.76±0.38^**#	62.49±6.22^**#	59.40±7.89^**#	80.60±18.9^**##	9(18.4)^#
NSTEMI组	31	7.18±1.07	1.95±0.33	59.22±5.67	56.00±5.40	50.00±16.4	1(3.2)
统计值		F=-6.131	F=-2.214	F=2.369	F=2.133	F=7.240	χ²=3.980
P值		0.000	0.030	0.020	0.036	0.000	0.046

组别	例数	R (min)	K (min)	Angle (°)	MA (mm)	Gensini评分 (分)	MACE [例(%)]
对照组	30	7.37±1.01	2.05±0.43	56.93±7.09	54.70±6.09	-	-
AMI组	80	6.29±1.26^**	1.83±0.37^*	61.23±6.19^**	58.06±7.19^**	69.00±23.1^##	10(12.5)^#
STEMI组	49	5.72±1.02^**	1.76±0.38^**#	62.49±6.22^**#	59.40±7.89^**#	80.60±18.9^**##	9(18.4)^#
NSTEMI组	31	7.18±1.07	1.95±0.33	59.22±5.67	56.00±5.40	50.00±16.4	1(3.2)
统计值		F=-6.131	F=-2.214	F=2.369	F=2.133	F=7.240	χ²=3.980
P值		0.000	0.030	0.020	0.036	0.000	0.046