血栓弹力图参数联合临床指标在急性缺血性脑卒中的诊断价值

doi:10.3969/j.issn.1671-2587.2023.02.020

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (2): 261-269.DOI: 10.3969/j.issn.1671-2587.2023.02.020

血栓弹力图参数联合临床指标在急性缺血性脑卒中的诊断价值

黎伟成, 吴正林, 吴昆仑, 蔡南盛, 朱国都, 蔡思齐

518000 中山大学附属第八医院输血科

收稿日期:2022-07-19 发布日期:2023-04-25
通讯作者: 蔡思齐,主要从事临床输血检验技术及相关实验研究,（E-mail）cai_siqi90@163.com。
作者简介:黎伟成,主要从事临床输血检验技术及输血治疗相关研究,（E-mail）308000179@qq.com。

Diagnostic Value of Thromboelastogram Parameters Combined with Clinical Indexes in Acute Ischemic Stroke

Li Wei-cheng, WU Zheng-lin, WU Kun-lun, et al

the Eighth Affiliated Hospital, Sun Yat-sen University. Department of Blood Transfusion, Shenzhen 518000

Received:2022-07-19 Published:2023-04-25

摘要/Abstract

摘要： 目的探讨血栓弹力图（TEG）联合临床指标在急性缺血性脑卒中（AIS）的诊断价值。方法纳入我院2020年5月~2022年1月于我院诊断急性缺血性脑卒中的患者120例为观察组,同期于我院住院非急性缺血性脑卒中患者70例为对照组。分别测定两组TEG、血脂代谢、凝血四项、D二聚体、空腹血糖、血常规。先后通过Lasso回归和Logistic逐步回归分析从上述候选指标中筛选出的最重要变量建立AIS联合诊断模型,并通过列线图呈现模型。受试者工作特征曲线（ROC）下的面积AUC、临床决策曲线和校准曲线分别用于评估模型区分度、临床使用价值和模型准确性。结果共筛选出6个变量用于建立AIS的诊断模型,分别为MA、GLU、CHOL、吸烟史、既往史、收缩压。得出AIS形成诊断模型的方程并建立列线图呈现模型。诊断模型ROC曲线下面积AUC为0.909,95%CI（0.868 4,0.950 1）。校准曲线分析结果提示模型预测AIS的风险与AIS实际发生风险相一致（Hosmer-Lemeshow检验,P=0.104）,临床决策曲线反映模型具有较好的临床应用价值,尤其阈值概率在0.6~1.0之间临床应用价值更为显著。结论运用Logistic逐步回归分析TEG各参数以及临床指标可建立AIS诊断模型,为临床AIS的预防及早期诊断提供实验室依据。

关键词: 血栓弹力图, 急性缺血性脑卒中, Logistic逐步回归

Abstract: Objective To investigate the diagnostic value of thromboelastogram parameters (TEG) combined with clinical indexes for acute ischemic stroke (AIS). Methods A total of 190 patients were enrolled in this study, including 120 acute ischemic stroke patients in the observation group and 70 other patients as the controls. Complete blood count, coagulation function, D-dimer, fasting blood glucose (GLU) and blood lipid parameters were analyzed. Lasso regression and logistic regression were used to screen variables for AIS diagnostic model presented by nomogram. Receiver operating characteristic (ROC) curve and area under curve (AUC), decision curve and calibration curve were applied respectively to evaluate the discrimination, accuracy and application value of the model. Results Six variables, i.e., MA, GLU, CHOL, smoke, history of acute ischemic and systolic pressure were selected to establish the AIS diagnostic model and draw the nomogram. The AUC of the diagnostic model was 0.909（95%CI:0.860 5, 0.945 3）.Calibration curve showed its good reliability of forecast and goodness of fit（Homer-Lemeshow, P=0.104）. Decision curve confirmed its pronounced application value when the probability threshold ranged between 0.6 and 1.0. Conclusion The MA of TEG and such clinical indexes as GLU, CHOL, and history of acute ischemic and systolic pressure could establish a diagnostic model of AIS, providing laboratory basis for the prevention and early diagnosis of AIS.

Key words: Thromboelastogram（TEG）, Acute, ischemic, stroke（AIS）, Logistic, regression

中图分类号:

R743.3

黎伟成, 吴正林, 吴昆仑, 蔡南盛, 朱国都, 蔡思齐. 血栓弹力图参数联合临床指标在急性缺血性脑卒中的诊断价值[J]. 临床输血与检验, 2023, 25(2): 261-269.

Li Wei-cheng, WU Zheng-lin, WU Kun-lun, et al. Diagnostic Value of Thromboelastogram Parameters Combined with Clinical Indexes in Acute Ischemic Stroke[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2023, 25(2): 261-269.

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血栓弹力图参数联合临床指标在急性缺血性脑卒中的诊断价值

Diagnostic Value of Thromboelastogram Parameters Combined with Clinical Indexes in Acute Ischemic Stroke

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