Evaluation The Clinical Application Of TAT,PIC,TM,t-PAIC And Their Value In The Early Warning Of LAA Ischemic Stroke

Objective:To evaluate the current clinical application of TAT,PIC,TM,t-PAIC through retrospective study,and explore the early warning value of four thrombus markers in large-artery atherosclerosis ischemic stroke（LAA）.Methods:（1）Collect information of patients who underwent thrombin antithrombin complex（TAT）,?2 plasmin inhibitor-plasmin complex（PIC）,thrombomodulin（TM）,tissue plasminogen activator-plasminogen activator inhibitor-1complex（t-PAIC）in two class A tertiary hospitals in Lanzhou from July 2020 to December 2022.To analyze the different level of four thrombus markers in different genders,ages,departments and diseases.At the same time,the test results of four thrombus markers from 40 healthy people were collected as control.Grouping 11clinical diseases which include ischemic stroke（IS）,rib fracture（RF）,gall-stones with cholecystitis（GWC）,cancers（CA）,deep-vein thrombosis（DVT）,obstructive jaundice（OJ）,deep vein thrombophlebitis（DVTP）,venous thromboembolism（VTE）,acute pancreatitis（AP）,gall-stones（GS）,multiple fractures（MF）.Mann-Whitney U test and ROC curve are used to analyze the-Log₁₀P values and diagnostic predictive values of four thrombus markers,TAT/PIC ratio and TAT/t-PAIC ratio in the above diseases respectively.（2）A total of 166 patients with LAA admitted in the Department of Neurology of Lanzhou University Second Hospital from January 2022 to September 2022 were enrolled（LAA group）.At the same time,71 patients with head and neck vascular atherosclerosis with neurological manifestations were enrolled as atherosclerosis controls（AS group）.The basic information,imaging data and laboratory examination results of the patients at admission were recorded.The first blood sample of the patients after admission was collected for supplementary examination of four thrombus markers.The independent influencing factors of LAA and joint warning model were determined by univariate difference analysis,and multivariate binary Logistic regression.ROC curve,nomogram,model calibration chart,decision curve analysis and Bootstrap verification method were used to evaluate and internally verify the model.Results:（1）The retrospective analysis included a total 10785 clinical lab test results from 3479 patients,of which 1012 patients who underwent both four thrombus markers meanwhile were suffered 122 different clinical conditions.（2）Compared with healthy controls（HC）,TAT,PIC and TAT/t-PAIC were significantly higher in 11diseases(-Log₁₀P>1.3).TM significantly increased in IS,CA,OJ,MF,GS,VTE,and the increase of TM in IS was most significant.t-PAIC increased significantly in DVT,VTE,DVTP,OJ,IS,GWC.TAT/PIC is significantly elevated in diseases other than OJ and VTE.（3）The AUC of four thrombus markers was the maximum for OJ（AUC=0.988）,and was 0.844 for IS.The AUC of TAT/PIC was the maximum for GWC（AUC=0.811）.The AUC of TAT/t-PAIC in AP was the maximum（AUC=0.847）.（4）The echo characteristics of carotid plaque（CP）,TM,MO,PDW,GLU,APA,Hcy and HBDH were independent influencing factors for the occurrence of LAA.The early-warning model including CP echo characteristic,TM,MO,PDW,GLU,APA and Hcy had good diagnostic efficacy for LAA.（5）Age and Lp（a）were independent risk factors for CP in LAA patients,while RBC,CO₂ and ALB were independent protective factors for CP.（6）TM and Lp（a）were independent risk factors for CP vulnerability in patients with LAA,while IG%,CREA and Fe were independent protective factors for CP vulnerability.Conclusion:The four thrombus markers were mainly used in clinical diseases related to pathological thrombosis tendency.The combined detection of four thrombus markers had good diagnostic value for IS.As a risk factor for LAA and CP vulnerability,TM has certain early warning value for the occurrence of LAA.