缺血性脑卒中患者外周血D-二聚体、hs-CRP及血小板参数在不同TOAST分型中的差异研究

Study on the Differences of D-dimer,hs-CRP and Platelet Parameters in Peripheral Blood of Patients with Ischemic Stroke in Different TOAST Classifications

目的探讨D-二聚体(D-D)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)及血小板相关参数在缺血性脑卒中不同TOAST分型中的差异。方法收集北部战区总医院2017年10月～2018年9月期间确诊的259例缺血性脑卒中患者作为病例组,按TOAST病因分型进行分类,同时收集同期健康体检者100例作为对照组,测定两组受试者的D-二聚体、超敏C反应蛋白、血小板计数(pletelet count,PLT)、血小板比积(thrombocytocrit,PCT)、血小板平均体积(mean platelet volume,MPV)以及血小板分布宽度(platelet distribution width,PDW)等指标,进行统计学分析。结果病例组按TOAST分型分为五类:大动脉粥样硬化(large-artery atherosclerosis,LAA)型81例,心源性栓塞(cardioembolism,CE)型17例,小动脉闭塞(small-artery occlusion,SAO)型103例,其他原因(stroke of determined etiology,SOE)型4例及不明原因(stroke of undetermined etiology,SUE)型54例。病例组患者D-D,hs-CRP,PLT,MPV,PDW水平与对照组相比,差异均具有统计学意义(|Z|=2.656～5.554,均P<0.05)。不同TOAST亚型与对照组相比,四组的D-D,hs-CRP,PDW水平、SAO型与CE型的PLT水平以及CE型的PCT,MPV水平差异均具有统计学意义(|Z|=2.208～5.216,均P<0.05)。不同TOAST亚型之间比较,CE型的D-D,PLT,PCT与其余三型之间差异具有统计学意义(|Z|=3.078～4.186,均P<0.05);LAA型与SAO型的D-D和hs-CRP差异具有统计学意义(|Z|=2.286,P=0.022;|Z|=2.946,P=0.003)。结论缺血性脑卒中不同TOAST亚型D-D,hs-CRP和血小板参数水平存在显著差异。D-D,PLT和PCT指标可用于临床上早期预测CE亚型,D-D和hs-CRP可用于LAA与SAO亚型的早期鉴别。

Objective To investigate the differences of D-dimer(D-D),high sensitivity C-reactive protein(hs-CRP)and platelet parameters in different TOAST classifications of ischemic stroke.Methods A total of 259 patients with ischemic stroke diagnosed during the period from October 2017 to September 2018 in the General Hospital of Northern Theater were collected as case groups and classified according to TOAST etiology classification.100 healthy subjects in the same period were also collected as the control group.The measurment and statistical analysis of D-D,hs-CRP,pletelet count(PLT),thrombocytocrit(PCT),mean platelet volume(MPV)and platelet distribution width(PDW)in the two groups were compared.Results The case group was divided into five categories according to the TOAST classification:81 cases of large-artery atherosclerosis(LAA)type,17 cases of cardioembolism(CE)type,103 cases of small-artery occlusion(SAO)type,4 cases of stroke of other determined etiology(SOE)type and 54 cases of stroke of undetermined etiology(SUE)type.The D-D,hs-CRP,PLT,MPV and PDW levels in the case group had statistically significant differences compared with the control group(|Z|=2.656-5.554,P<0.05).Different TOAST subtypes compared with the control group,the differences of D-D,hs-CRP,PDW in four subtypes,PLT in SAO type,PLT,PCT and MPV in CE type were all significant(|Z|=2.208-5.216,P<0.05).Compared in different TOAST subtypes,the D-D,PLT and PCT levels in CE and the other three subtypes were sig-nificant(|Z|-3.078-4.186,P<0.05),and the differences of D-D,hs-CRP were also significant between LAA and SAO(|Z|-2.286,P=0.022;|Z|-2.946,P=0.003).Conclusion There were significant differences in the levels of D-D,hs-CRP and platelet parameters in different TOAST subtype in ischemic stroke.The D-D,PLT and PCT can be used for clinical early prediction of CE subtypes,and the D-D,hs-CRP can be used for early identification of LAA and SAO subtypes.