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目的：运用CRUSADE 评分系统联合血栓弹力图对急性冠脉综合征（acute coronary syndrome，ACS）患者抗栓治疗中的出血风险进行评估。方法：回顾性分析2013年1 月至2013 年12 月在上海交通大学医学院附属新华医院住院的ACS 患者病历249 例，用CRUSADE 评分联合血栓弹力图评估ACS 患者30 天出血事件的发生。结果：随访的249例ACS 患者，共有46 例（18.5%）患者发生了出血事件；按照CRUSADE 评分进行危险分层，极低危组、低危组、中危组、高危组、极高危组的出血率分别为：15%、 7.5%、21.2%、32.5%26.7%；各组间出血率的比较：中危组、高危组及极高危组各组的出血率均高于低危组，差异有统计学意义；而高危组出血率高于极低危组，差异有统计学意义，而极低危组与其他各组比较，差异无统计学意义；低危组以上患者出血率高于低危组以下，差异有统计学意义。低危组以上中危组、高危组及极高危组各组间出血率比较，差异无统计学意义；按照血小板抑制率中位数分组，大于中位数组的出血率高于小于中位数组，差异有统计学意义。经多因素Logistic 分析：PAgT 抑制率(ADP)是 ACS患者抗栓治疗中出血事件的独立影响因素。利用ROC曲线分析CRUSADE 评分、血栓弹力图以及两者联合对患者出血事件发生的评估，两者联合的曲线下面积大于单独利用CRUSADE 评分。结论：随着CRUSADE 评分危险分层的增加出血的发生率亦呈增加趋势；危险分层低危以上的患者，不论中危、高危、极高危发生出血事件风险较低危险以下有明显增加；血栓弹力图监测血小板抑制率可作为CRUSADE 评分的补充，提高对ACS患者出血风险的预测。

英文摘要:

Objective:To evaluate the application of CRUSADE scoring system in combination with thromboelastography (TEG) in prediction of hemorrhage in patient with ACS during antithrombotic therapy.Methods:CRUSADE scoring system was calculated and TEG was recorded in randomly collected 328 patients with ACS who were hospitalized in Xin Hua hospital Affiated to Shanghai Jiao Tong University of medicine fromJanuary 2013 to December 2013. All the patients were followed up 30 days to observe whether hemorrhage took place or not.79 of 328 patients were lost in follow-up.Results:There were 49 patients with hemorrhage in the 249 study population, and the bleeding rate was 18.5%. The 249 study patients were divided into five groups according to CRUSADE scoring system. Hemorrhage incidence rate from extremely-low-risk group to extremely-high-risk group were 15% 7.5%21.2% 32.5%26.7%. The comparisons of bleeding rate between each group The hemorrhage incidence rate of moderate-risk group, high-risk group and extremely- high-risk group was significant higher than extremely-low-risk group statistically. But only the high-risk group,s hemorrhage incidence rate of was higher than extremely-low-risk group, the other groups between extremely-low-risk group had no difference in statistically. Overall, the patients over low-risk group had higher bleeding rate. The bleeding rate of each group between moderate-risk group,high-risk group and extremely-high-risk group was considered without statistical significance .Patients were grouped by the median of platelet aggregation inhibition, those platelet aggregation inhibition greater than the median had greater bleeding rete. By multiple Logistic regression model, PAgT%(ADP)was identified the independent factor of hemorrhage. Using of ROC curve to evaluate CRUSADE scoring system, TEG and in combination of the two in prediction of hemorrhage inpatients with ACS. The area of ROC curve of the two in combination was bigger than CRUSADE scoring system.Conclusion:The incidence rate of hemorrhage raises with the increase of CRUSADE score. Patients above low-risk have higher risk of bleeding. TEG can be the supplement of CRUSADE scoring systems .In combination with TEG, the CRUSADE scoring systemcan be more productive in prediction of hemorrhage risk in patients with ACS.

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