急性脑梗死患者血浆D-二聚体水平变化及其与病情和预后的关系研究

Changes of Plasma D-dimer Level and Its Relationship to Illness Severity and Prognosis in Patients with Acute Cerebral Infarction

目的探讨急性脑梗死患者血浆D-二聚体水平变化及其与病情和预后的关系。方法选取常熟市第二人民医院神经内科2012年收治的259例急性脑梗死患者作为梗死组，选取同期200例体检健康者作为对照组，梗死组患者于入院24h内、对照组受检者于体检当日清晨空腹采集静脉血栓测血浆D-二聚体水平。按入院当天美国国立卫生研究院卒中量表（NIHSS）评分将梗死组患者分为轻型（0～15分）组129例、中型（16～25分）组92例、重型（26～33分）组38例。按预后（即住院4周时NIHSS评分）将梗死组患者分为好转组182例和无好转组77例。比较对照组与梗死组、梗死组各亚组间血浆D-二聚体水平及D-二聚体异常率。结果梗死组血浆D-二聚体水平为（0．46±0．52）mg／L、D-二聚体异常率43．2％，均高于对照组的（0．13±0．29）iTIg／L、1．0％（P〈0．05）。轻型组患者血浆D-二聚体水平为（O．27±0．13）mg／L、D-二聚体异常率30。5％，分别低于中型组的（O．42±0．28）mg／L、47．8％，中型组又低于重型组的（0．65±0．32）mg／L、76。3％（P〈0．05）。好转组患者血浆D-二聚体水平为（0．31±0．26）mg／L、D～二聚体异常率32．9％，低于无好转组的（0.57±0．29）mg／L、67．5％（P〈0．05）。结论急性脑梗死患者血浆D-二聚体水平明显升高，且血浆D-二聚体水平越高患者病情越严重、预后越差。

Objective To investigate the changes of plasma D - dimer level and its relationship to illness severity and prognosis in patients with acute cerebral infarction. Methods In 2012 in the Second People＇s Hospital of Changshu, 259 pa- tients with acute cerebral infarction were selected as case group, 200 healthy cases were selected as control group. Case group detected plasma D - dimer level in the first 24 hours ＂after admission, control group detected plasma D - dimer level on the day of examination. According to NIHSS score, patients of case group were divided into slight group （0 to 15 points, n = 129）, mild group （ 16 to 24 points, n = 38）, severe group （26 to 33 points, n = 38） ; according to the prognosis （ NIHSS score after 4 weeks of admission） , patients of case group were divided into A group （with better prognosis, n = 182） and B group （with general prognosis, n = 77）. Plasma D - dimer level and abnormal rate of D - dimer between case group and control group, a- mong different subgroups were compared. Results The plasma D -- dimer level of case group was （ 0. 46 ± 0. 52 ） mg/L, the abnormal rate of D - dimer was 43.2% , was higher than that of control group of （0. 13 ±0. 29） rag/L, 1.0% , respectively （P 〈0. 05） . The plasma D -dimer level of slight group was （0. 27 ± 0. 13） mg/L, the abnormal rate of D -dimer was 30. 5%, was lower than that of mild group of （ 0. 42 ± 0. 28 ） mg/L, 47. 8% , respectively （ P 〈 0. 05 ）, and that of mild group was lower than that of severe group of （0. 65 ±0. 32） mg/L, 76. 3% , respectively （P 〈0. 05） . The plasma D - dimer level of A group was （0. 31 ± 0. 26） mg/L, the abnormal rate of D - dimer was 32. 9% , was lower than that of B group of （0. 57 ± 0. 29） rag/L, 67. 5%, respectively （ P 〈 0. 05 ）. Conclusion The plasma D - dimer level is signifieantly increased in patients with acute cerebral infarction, and the higher plasma D -dimer level, the more serious illness and worse prognosis.