目的 探讨脑血管疾病患者血栓弹力图(TEG)参数和纤维蛋白原(Fg)的关系.方法 选取470例脑血管疾病患者[腔隙梗死组70例、脑梗死组400例(单纯脑梗死组73例、合并高血压组200例、合并糖尿病组27例、合并高血压及糖尿病100例)]和50名健康体检者(对照组).应用TEG-5000血栓弹力仪测定所有对象的TEG各项参数[K值、angle(A)角、MA值]；同时应用ACL-TOP全自动凝血分析仪检测Fg水平,应用LH 750全自动血液分析仪测定血小板数量(PLT)、平均血小板体积(MPV).结果 Fg与K值呈负相关(r=-0.134、P=0.000);与A角、MA值、PLT呈正相关(r=0.210、P =0.000;r =0.251、P=0.000; r=0.122、P =0.000)；与MPV无相关性(r =-0.007、P=0.957).腔隙梗死组、脑梗死组A角、MA值及PLT、Fg水平高于对照组(P＜0.05、P＜0.01).脑梗死组MPV高于对照组(P＜0.05),而腔隙梗死组与对照组之间差异无统计学意义(P＞0.05).K值在腔隙梗死组、脑梗死组及对照组之间差异均无统计学意义(P＞0.05).脑梗死合并糖尿病组MA值明显高于单纯脑梗死组和脑梗死合并高血压组(P＜0.05)；脑梗死合并糖尿病组和脑梗死合并糖尿病及高血压组Fg水平高于脑梗死合并高血压组(P＜0.05)；其余参数各组间均无差异.结论 在脑血管疾病的发生过程中存在着PLT数量、质量、形态和Fg水平的改变.Fg与TEG参数存在明显的相关性.TEG检测可以作为对脑血管疾病具有实用价值的筛选试验之一.%Objective To investigate the relationship of thrombelastograph (TEC) parameters with fibrinogen(Fg) in patients with cerebrovascular disease. Methods A total of 470 patients with cerebrovascular disease [70 patients with cavity infarction and 400 patients with cerebral infarction (73 patients with pure cerebral infarction, 200 cerebral infarction patients with high blood pressure, 27 cerebral infarction patients with diabetes mellitus and 100 cerebral infarction patients with high blood pressure and diabetes mellitus) ] and 50 healthy controls were enrolled. TEG-5000 TEC analyzer (TEG-5000) was used to determine the parameters of K value,angle (A) value and MA value. The Fg level was detected by ACL-TOP automatic blood coagulation analyzer. The platelet (PLT) count and mean platelet volume(MPV)weTe detected by LH 750 automatic blood analyzer. Results There was negative correlation between Fg level and K value(r= -0. 134, P =0.000). There was positive correlation between Fg level and A value,MA value and PLTcount(r = 0. 210,P = 0. 000;r = 0.251,P = 0. 000;r =0. 122,P =0. 000). There was no correlation between Fg level and MPV(r= -0.007; P = 0.957). The A value,MA value,PLT count and Fg level in cavity infarction group and cerebral infarction group were higher than those in the control group( P <0.05,P <0.01). MPV value in cerebral infarction group was higher than that in the control group(P<0.05), but there was no statistical significance between cavity infarction group and the control group (P > 0. 05). The K value had no statistical significance among cavity infarction group, cerebral infarction group and the control group (P >0. 05). The MA value in cerebral infarction patients with diabetes mellitus was higher than that in patients with pure cerebral infarction and cerebral infarction patients with high blood pressure (P <0.05). The Fg levels in cerebral infarction patients with diabetes mellitus and cerebral infarction patients with diabetes mellitus and high blood pressure were higher than those in cerebral infarction patients with hieh blood pressure( P < 0.05). The other parameters had no difference between each group. Conclusions In the process of cerebrovaseular disease,there are changes of PLT quantity,quality,form and Fg level. Fg and TEG parameters have obvious correlation. TEG determination with the practical value can be one of the screening tests for cerebrovascular disease.
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