心房颤动和D-dimer联合对急性脑梗死的诊断价值

Research on the value of atrial fibrillation combined with D-dimer in the diagnosis of acute cerebral infarction

目的:探讨心房颤动(atrial fibrillation,AF)和血浆D-二聚体(D-dimer)联合对急性脑梗死的诊断价值。方法:选择2006年1月至2015年6月神经科收治的367例患者,按有无急性脑梗死发作将其分为梗死组(170例)与非梗死组(197例),比较两组患者的一般情况及病史、血液生化检查、心电图检查,用单因素与多因素Logistic回归分析急性脑梗死发作的独立危险因素,并绘制ROC曲线评价AF联合D-dimer对急性脑梗死的诊断价值。结果:两组患者的一般情况及病史、总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL)、高密度脂蛋白(high density lipoprotein,HDL)及血小板计数(platelet count,PLT)等血液生化指标相比,差异无统计学意义(P>0.05),而梗死组的AF阳性率与D-dimer阳性率高于非梗死组(P<0.05)。多因素分析AF阳性、D-dimer阳性是急性脑梗死发作的独立危险因素,AF阳性时发生急性脑梗死的危险是AF阴性的5.397倍,D-dimer阳性时发生急性脑梗死的危险是D-dimer阴性的5.003倍。在ROC曲线中AF联合D-dimer的曲线下面积为0.663,灵敏度为0.774,特异度为0.658,诊断价值较高。结论:AF联合血浆D-dimer诊断急性脑梗死的应用价值较高,值得关注。

Objective：To explore the value of atrial fibrillation （AF） combined with D - dimer in the diagnosis of acute cerebral infarction. Methods：367 cases treated in the department of neurology from January 2006 to June 2015 were divided into infarct group （ 170 cases） aM non- infarct group （197 cases）. The general information, history of disease, blood hiocbemieal exam- ination, and electrocardiogram examination were compared in the two groups. Single factor/multi - factor logistic regression analysis was used to analyze the independent risk factors of acute cer- ebral infarction. ROE curve was used to evaluate the value of AF combined with D - dimer in the diagnosis of acute cerebral infarction. Results：The general information, history of disease and level of total cholesterol （TC）, low density lipopratein （LDL）, high density lipoprotein （HDL）, platelet count （PLT） showed no statistically significant difference between the two groups （ P 〉 0.05 ）. The positive rate of AF and D - dimer in infarct group was obviously higher than that of the non - infarct group （ P 〈 0.05）. Multi - factor logistic regression analysis showed AF and D - dimer positive was independent risk factor of acute cerebral infarction. When AF was positive, the risk of acute cerebral infarction was 5. 397 times of AF negative, while D - dimer positive brought about the risk of acute cerebral infarction 5. 003 times of D - dimer negative. ROC curve showed the AUC when AF combined with D - dimer was 0.663, sensitivity 0.774, specificity 0. 658. Conelttsion： Combined diagnosis of AF and D - dimer is of great application value, which is worth attention.