血浆纤维蛋白原和D-二聚体水平与进展性卒中关系的研究

Relationship between the concentrations of plasma fibrinogen and D-dimer and progressive ischemic stroke

目的探讨缺血性卒中患者血浆纤维蛋白原(Fib)、D二-聚体(D-dimer)水平的动态变化,揭示其在卒中进展中的作用及早期诊断价值。方法用酶联免疫吸附试验(ELISA)法、全自动血凝仪分别检测50例完全性缺血性卒中、40例进展性卒中患者发病24h内、第3天、第7天、第14天、第21天及40例正常对照者血浆D-dime、rFib水平,并对缺血性卒中组患者相应的神经功能缺损情况进行斯堪地那维亚量表(SSS)评分。结果完全性卒中组发病24h内血浆F ib水平显著高于正常对照组,差异有统计学意义(P<0.01),第3天时有下降趋势,第7天时降至正常。进展性卒中组发病24h内血浆Fib水平较完全性卒中组升高更明显(P<0.01),3d时达最高峰,14d降至正常。完全性卒中组发病24h内血浆D-dim er水平较正常对照组明显升高(P<0.01),3d时达高峰,7d降至正常,而进展性卒中组发病24h较完全性卒中组明显升高(P<0.01),至第7天达高峰,第14天迅速降至正常。进展性卒中组3w时神经功能缺损恢复较完全性卒中组为差(P<0.01)。结论对缺血性卒中患者进行血浆F ib和D-d im er水平的动态监测,有助于早期预测进展性卒中的发生,进展性缺血性卒中有更明显的高凝状态。

Objective To investigate the dynamic changes of plasma fibrinogen and D-dimer levels in patients with acute ischemic stroke,and to evaluate the collective role of them in pathogenesis of progressive ischemic stroke and the early diagnosis value.Methods The levels of plasma fibrinogen and D-dimer were detected in 50 cases with complete ischemic stroke,40 cases with progressive ischemic stroke and 40 cases of normal control within 24h of onset,on 3d,7d,14d and 21d.The resulting neurological deficit of patients with acute ischemic stroke were judged according to the Scandinavian Stroke Scale（SSS）.Results The plasma fibrinogen levels of complete ischemic stroke within 24h of onset markedly increased as compared with the normal control group with statistically significant difference（P〈0.01）,then decreased on 3d,and returned to normal level on 7d.The plasma fibrinogen levels of progressive ischemic stroke within 24hof onset markedly increased as compared with the complete stroke（P〈0.01）,and reached the peak on 3d,then decreased on 7d.The plasma D-dimer levels of complete ischemic stroke within 24h of onset markedly increased as compared with the normal control group with statistically significant difference（P〈0.01）,and reached the peak on 3d,then decreased to normal on 7d.The plasma D-dimer levels of progressive ischemic stroke within 24h of onset markedly increased as compared with the complete stroke（P〈0.01）,and reached the peak on 7d,then decreased to normal rapidly on 14d.The return of the resulting neurological deficit of progressive ischemic stroke was worse than the complete stroke at the end of 3 weeks（P〈0.01）.Conclusion The dynamic observation of plasma fibrinogen and D-dimer of acute ischemic stroke may has an early prognostic value on progressive ischemic stroke.There is a more significant curdling state in progressive ischemic stroke.