脑梗死溶栓治疗中血浆D-二聚体动态变化的临床意义

Clinical value of dynamical changes of plasma D-dimer in patients with acute cerebral infarction who received thrombolysis therapy

目的探讨在急性脑梗死(ACI)溶栓治疗中D-二聚体所发生的变化同疾病的关系。方法62例ACI患者分别在溶栓治疗前及治疗后1、3、5、8、14、21天测定其血浆中D-二聚体的含量的变化,并对不同患者D-二聚体的变化,参照影像学检查结果、病情轻重、神经功能缺损程度进行动态观察。另设正常对照组(20例)进行对比观察。结果ACI患者血浆D-二聚体与正常对照组相比明显增高(2.41±0.64)mg/Lvs(0.21±0.20)mg/L(P<0.01),并与病情轻重、梗死灶大小明显相关;溶栓治疗后病情缓解的患者,D-二聚体渐趋正常,如居高不降或者继续升高显示治疗效果及预后差。结论ACI患者纤溶/凝血功能平衡失常,溶栓治疗可有效的调节这种失衡,血浆D-二聚体的动态检测,对患者病情轻重的判断,溶栓治疗效果的评估以及患者功能缺损程度的预测均有着重要的参考价值。

Objective To investigate the relationship between the change of plasma D-dimer and prognosis in patients with acute cerebral infarction （ACI） who received thrombolysis therapy. Methods Blood samples from 62 patients with ACI were collected. To detect D-dimer respectively before thrombolysis therapy and after thrombolysis therapy in 1,2,3,4,5,8,14 and 21 days. The results of image, severity of the disease, degree of neurodysfunction were observed and comparatively analyzed with those of normal control group （20 cases）. Results The D-dimer level of patients with ACI was significantly higher than that in control group （2.41±0.64） mg/L vs （0.21±0.20） mg/L （P 〈 0.01）. The level of D-dimer was correlated with the severity of disease and the infarction size. When the level of D-dimer gradully became normal after thrombolysis therapy,the patients recovered soon. That D-dimer was still in high level suggests the treatment was not effective and the prognosis was bad. Conclusion There were some abnormalities in coagulative and fibrinolytic system in patients with ACI. Thromholysis therapy could effectively adjust the imbalance. The dynamical detection of D-dimer is useful for the judgement of severity of the disease and effective for evaluation of thrombolysis therapy and forecasting neurodysfunction in the patients.