Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Brain Behav. 2023 Apr;13(4):e2961. doi: 10.1002/brb3.2961. Epub 2023 Mar 16.
To investigate the hypercoagulability of hepatocellular carcinoma (HCC)-related cerebral infarction (HCRCI) with thromboelastography (TEG).
A multicenter prospective study was conducted in HCRCI patients, HCC patients without cerebral infarction, and acute cerebral infarction (ACI) patients without HCC between January 2016 and December 2019. TEG parameters and laboratory and clinical data were collected and compared among the three groups. To confirm the independent risk factors of HCRCI, multivariate analyses were conducted. Receiver operating characteristic (ROC) curves were utilized to evaluate the area under the curve (AUC) plotted by each independent risk factor.
There were 38 patients recruited in the HCRCI group, and 152 patients were recruited to the HCC group and the ACI group. The levels of plasma neutrophil count, D-dimer, α-fetoprotein (AFP), carcinoembryonic antigen, and maximum amplitude (MA)-a parameter of TEG-were significantly higher in the HCRCI group than HCC and ACI groups. Multivariate logistic regression analysis showed that increased neutrophile count, D-dimer, AFP, and MA were independently associated with HCRCI. ROC curve analysis showed first that AUC of MA for HCRCI was .875, which was larger than the other risk factors, and second that the optimal cutoff value for MA was 61.35, with a sensitivity of 89.50% and specificity of 66.40%.
It was suggested that TEG disclosed that the pathogenesis of HCRIC is exactly related to the hypercoagulability. And with a cutoff value of MA equaling to 61.35, TEG facilitates clinicians to identify HCC patients at high risk of HCRIC.
应用血栓弹力图（TEG）探讨肝细胞癌（HCC）相关脑梗死（HCRCI）的高凝状态。
本研究为多中心前瞻性研究，纳入了 2016 年 1 月至 2019 年 12 月间 HCRCI 患者、无脑梗死的 HCC 患者和无 HCC 的急性脑梗死（ACI）患者。比较三组 TEG 参数及实验室和临床资料。采用多因素分析明确 HCRCI 的独立危险因素。利用受试者工作特征（ROC）曲线评估各独立危险因素绘制曲线的 AUC。
共纳入 38 例 HCRCI 患者，HCC 组和 ACI 组分别纳入 152 例患者。HCRCI 组患者的血浆中性粒细胞计数、D-二聚体、甲胎蛋白（AFP）、癌胚抗原和最大振幅（MA）水平均显著高于 HCC 组和 ACI 组。多因素 logistic 回归分析显示，中性粒细胞计数、D-二聚体、AFP 和 MA 升高与 HCRCI 独立相关。ROC 曲线分析显示，MA 对 HCRCI 的 AUC 为 0.875，大于其他危险因素，MA 的最佳截断值为 61.35，其灵敏度为 89.50%，特异度为 66.40%。
TEG 显示 HCRCI 的发病机制与高凝状态密切相关。TEG 有助于临床医师识别发生 HCRCI 风险较高的 HCC 患者，截断值设定为 MA 等于 61.35。
