急性脑卒中患者575例D-二聚体等凝血指标的诊断价值

THE DIAGNOSTIC VALUE OF D-DIMER AND OTHER COAGULATION INDICATORS IN ACUTE STROKE

目的探讨凝血指标D-二聚体(D-D)、凝血酶原时间(PT)、国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、抗凝血酶Ⅲ(AT-Ⅲ)和纤维蛋白原(FIB)在急性脑卒中患者中的临床诊断价值。方法选择该院神经内科收治的急性脑卒中患者575例,于治疗前检测其血浆D-D、PT、INR、APTT、AT-Ⅲ和FIB,并与60例健康体检者比较。结果年龄是脑卒中的危险因素,高龄人群更易发生缺血性脑卒中。脑卒中患者D-D、APTT、FIB检测结果显著高于健康对照组,且出血性脑卒中患者D-D和FIB水平明显高于缺血性脑卒中患者,差异均有统计学意义(P<0.017)。D-D与脑卒中有相关性,当D-D值为0.70μg/ml时,对急性缺血性和出血性脑卒中的鉴别诊断效率最高,敏感性和特异性分别为76%和60%,高于FIB的诊断效率。结论 D-D、APTT和FIB的检测有助于急性脑卒中的诊断,尤其是D-D的检测对鉴别急性缺血性脑卒中和出血性脑卒中具有一定的临床诊断价值。

Objective To investigate the diagnostic value of coagulation-related biomarker in acute stroke . Methods This study enrolled 575 consecutive patients with acute ischemic stroke and hemorrhagic stroke and 60 healthy person as control group .Blood samples were drawn before treat and serum levels of D-di-mer（D-D） ,prothrombin time （PT ） ,international normalized ratio （INR） ,activated partial thromboplas-tin time （APTT） ,antithrombin Ⅲ （AT - Ⅲ） and fibrinogen （FIB） were measured .Results Age is a risk factor for stroke ,the aged is more susceptible to ischemic stroke .The levels of D -D ,APTT and FIB were higher in acute stroke patients than the control group .Compared with ischemic stroke patients ,D-D and FIB levels were significantly enhanced in hemorrhagic stroke patients （P〈0 .05） .There were correla-tion between D-dimer and acute stroke .The multivariate model demonstrated modest discriminative capa-bilities with an area under the receiver operating characteristic curve of 0 .73 for acute stroke when the value of D-dimer is 0 .70 μg/ml ,the sensitivity and specificity were 76% and 60% separately ,which were sig-nificantly higher than FIB .Conclusions These results suggest that a biomarker panel of D-dimer ,APTT and FIB may add valuable and time-sensitive diagnostic information in the acute stroke ,especially in the detection of D -dimer may have clinical value in differentiating acute ischemic stroke and hemorrhagic stroke .