缺血性脑梗死患者血浆D-二聚体测定的意义

Evaluation of detaicted D-dimer in plasma of patients with cerebral ischemic infarction

目的 为了解缺血性脑梗死病人在不同阶段血浆 Ｄ－ 二聚体测定的意义。方法 随机选择８４ 例到本院急诊科就诊的缺血性脑梗死患者（ 年龄５１ ～９０ 岁，男性４２ 例，女性４２ 例） ，分别于急性期（ ＜ ６ 天，ｎ ＝ ５３ ，年龄５１ ～８７ 岁，平均７０ 岁） 和亚急性期（６ ～２０ 天，ｎ ＝ ３１ ，年龄５３ ～９０ 岁，平均７２ 岁） 行血浆 Ｄ－ 二聚体测定。全部患者均经头颅 Ｃ Ｔ 或 Ｍ Ｒ Ｉ证实为缺血性脑梗死。同时选择年龄相匹配的２０ 例其他非凝血及血栓性疾病患者（ 年龄６０ ～９５ 岁，平均７２ 岁） 作为对照组。结果 缺血性脑梗死患者的血浆 Ｄ－ 二聚体水平在急性期未见升高（ ＜ ０３ｍｇ／ Ｌ） ，而在亚急性期显著升高（ ≥０３ ｍｇ／ Ｌ，０３ ～２ ｍｇ／ Ｌ） ，亚急性期与对照组（ ＜ ０３ ｍｇ／ Ｌ） 比较有显著差异（ Ｐ＜ ００００１） ，与急性期比较也有显著差异（ Ｐ＜ ００００１）（ 正常值为＜ ０３ ｍｇ／ Ｌ） 。结论 缺血性脑梗死患者的纤溶系统显著激活并非在急性期，而是在亚急性期。这也为急性期进行溶栓治疗提供了依据。

Objective The purpose of this study was to clarify differences in fibrinolytic activation among the various phases of cerebral ischemic infarction. Methods D-dimer were measured in 84 patients with cerebral ischemic infarction(51～90 years, men 42, female 42) and with 20 age-matched controls. All 84 patients were divided into two groups,53 cases were during acute phases(<6days)and 31 cases were during subacute phases(6～20 days). Results The levels of D-dimer were significantly higher (≥0 3 mg/L, 0.3～2 mg/L) during subacute phases of cerebral ischemic infarction than controls (<0.3 mg/L, P< 0.0001), however, the levels of D-dimer were not elevated (<0.3 mg/L) during the acute phases of cerebral ischemic infarction (normal was <0.3 mg/L), and less than subacute phases( P< 0.0001).Conclusion Our finding suggest that fibrinolytic activations were significantly increased during subacute phases of cerebral ischemic infarction, and were not increased during acute phase. [