摘要
目的探讨血浆大内皮素1(Big ET-1)与D-二聚体(D-Dimer)联合检测预测急性缺血性脑卒中再出血的临床价值。方法选取2012年1月—2013年12月齐河县人民医院收治的急性缺血性脑卒中患者120例,患者均于入院次日采集静脉血检测D-Dimer、凝血酶原时间(PT)及国际标准化比值(INR)以及血小板计数(PLT),另采用酶联免疫吸附法(ELISA)检测Big ET-1。患者出院后随访3个月,记录其发生再出血的例数。根据患者是否存在再出血将其分为出血组和对照组,比较两组患者Big ET-1、D-Dimer、PLT、PT及INR;采用Logistic回归分析影响患者发生再出血的因素。运用ROC曲线评估Big ET-1与D-Dimer对急性缺血性脑卒中再出血的最佳预测值。结果出血组54例,对照组66例。两组患者性别、年龄、体质指数比较,差异均无统计学意义(χ2性别=0.412,t年龄=1.027,t'体质指数=1.358,P>0.05)。出血组和对照组PLT、PT及INR比较,差异均无统计学意义(P>0.05);出血组血浆Big ET-1和D-Dimer水平均高于对照组(t=3.175、3.629,P<0.05)。多因素Logistic回归分析结果显示,血浆Big ET-1和D-Dimer是急性缺血性脑卒中再出血的危险因素(P<0.05)。Big ET-1和D-Dimer预测急性缺血性脑卒中再出血的ROC曲线下面积分别为0.804和0.665。但当Big ET-l≥1.42 pmol/L和D-Dimer≥0.68 mg/L为切点,对判断再出血的灵敏度为43.8%,特异度为75.2%,准确度为57.4%,ROC曲线下面积为0.857。结论血浆Big ET-1与D-Dimer联合检测对急性缺血性脑卒中再出血具有较好的预测价值。
Objective To analyze the predictive value of combined detection of the plasma big endothelin- 1( Big ET-1) and D-Dimer on rehemorrhage in patients with acute ischemic stroke. Methods 120 patients with acute ischemic stroke admitted to People' s Hospital of Qihe County from January 2012 to December 2013 were selected. The D- Dimer,PT,INR and PLT levels were tested the second day after hospitalization. ELISA was used to test Big ET- 1. After discharge,the patients were followed up for three months,and the cases of rehemorrhage was recorded. The patients were then divided into hemorrhage group and control group based on the rehemorrhage status. The Big ET- 1,D- Dimer,PLT,PT and INR levels of the two groups were compared. Logistic regression analysis was used to analyze the influencing factors for rehemorrhage. The best cutoff points of Big ET- 1 and D- Dimer for predicting rehemorrhage were confirmed by the areas under the receiver operating curve( ROC). Results The sex,age and BMI of the hemorrhage group( 54 cases) and control group( 66 cases) showed no statistically significant difference( χ2sex= 0. 412,tage= 1. 027,t'BMI= 1. 358,P〉 0. 05). The PLT,PT and INR levels of the two groups showed no statistically significant difference( P〉 0. 05). The levels of Big ET- 1 and D- Dimer in the hemorrhage group were both higher than those of the control group( t = 3. 175,3. 629,P〈 0. 05). Multivariate Logistic regression analysis showed that Big ET- 1 and D- Dimer were the risk factors for the rehemorrhage of acute ischemic stroke( P〈 0. 05). The area under ROC curve of Big ET- 1 and D- Dimer in predicting rehemorrhage was 0. 804 and 0. 665 respectively. When Big ET- 1≥1. 42 pmol/L and D-Dimer≥0. 68 mg/L were chosen as the cutoff point,the sensitivity,specificity,accuracy in predicting rehemorrhage was 43. 8%,75. 2% and 57. 4% respectively,and the area under ROC was 0. 857. Conclusion The combined detection of the plasma Big ET- 1 and D- Dimer has excellent predictive value for cerebral rehemorrhage in patients with acute ischemic stroke.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第33期3926-3929,共4页
Chinese General Practice
关键词
脑缺血
脑出血
大内皮素1
D-二聚体
预测
Brain ischemia
Cerebral hemorrhage
Big endothelin-1
D-Dimer
Forecasting