血浆D-二聚体和总同型半胱氨酸水平与不同分型急性脑梗死的关系研究

Study on the relationship between plasma D-dimer, total homocysteine and different types of acute cerebral infarction

目的观察急性脑梗死(acute cerebral infarction,ACI)患者血浆D-二聚体(D-dimer,DD)和总同型半胱氨酸(totalhomocysteine,tHcy)水平变化,探讨其在ACI病因学诊断中的临床意义。方法选取2016年4月至2019年4月本院神经内科住院的120例ACI患者纳入ACI组,根据TOAST(The Trial of Org 10172 in Acute Stroke Treatment)病因分型标准将其分为大动脉粥样硬化(large-artery atherosclerosis,LAA)型、小动脉闭塞(small-artery occlusion,SAO)型、心源性栓塞(cardioembolism,CE)型、其他明确病因(stroke of other determined cause,OC)型、不明原因(stroke of undetermined cause,UND)型;另选取本院同期50例健康体检者纳入对照组。检测两组研究对象血浆DD和tHcy水平,并分析其在ACI组和对照组以及不同分型ACI之间的差异。结果 ACI组患者血浆DD和tHcy水平均显著高于对照组(均P < 0.05)。Logistic回归分析显示,血浆DD和tHcy水平均与ACI具有相关性(均P < 0.05)。LAA型、CE型、SAO型患者血浆DD和tHcy水平均显著高于对照组(均P < 0.05),其中CE型患者DD水平显著高于其他分型患者(均P < 0.05),LAA型患者tHcy水平显著高于其他分型患者(均P < 0.05),由于OC型和UND型患者数较少,故未进行分析。Logistic回归分析显示,DD和tHcy水平均与TOAST分型具有相关性(均P < 0.05),且DD水平与CE型的相关性最强(OR = 7.660,95%CI :4.043 ~ 14.512),tHcy水平与LAA型的相关性最强(OR = 5.078,95%CI :2.939 ~ 8.774)。结论血浆DD和tHcy水平可能是导致ACI发生的独立危险因素,且其在不同TOAST分型ACI患者中的表达水平存在差异,CE型患者DD水平升高最明显,LAA型患者tHcy水平升高最明显,这对ACI的病因学诊断具有重要的提示作用。

Objective To observe the changes of plasma D-dimer (DD) and total homocysteine (tHcy) in patients with acute cerebral infarction (ACI), and to explore the clinical significance of plasma DD and tHcy in the etiological diagnosis of ACI. Method A total of 120 patients with ACI hospitalized in the department of neurology of our hospital from April 2016 to April 2019 were enrolled in ACI group, according to the etiological classification criteria of TOAST (The Trial of Org 10172 in Acute Stroke Treatment), they were divided into large-artery atherosclerosis (LAA) type, small-artery occlusion (SAO) type, cardioembolism (CE) type, stroke of other determined cause (OC) type, stroke of undetermined cause (UND) type;in addition, 50 healthy persons who underwent physical examination in the same period of our hospital were selected into control group. The levels of plasma DD and tHcy in the two groups were measured, and the differences between ACI group and control group and different types of ACI were analyzed. Result The levels of plasma DD and tHcy in ACI group were significantly higher than those in control group (all P<0.05). Logistic regression analysis showed that plasma DD and tHcy levels were correlated with ACI (all P < 0.05). The levels of plasma DD and tHcy in patients with LAA type, CE type and SAO type were significantly higher than those in control group, and the levels of DD in patients with CE type was significantly higher than that in patients with other types (all P < 0.05). The level of tHcy in patients with LAA type was significantly higher than that in patients with other types (all P < 0.05). There was no analysis because of the small number of patients with OC type and UND type. Logistic regression analysis showed that there was a correlation between the levels of DD and tHcy and TOAST classification (all P < 0.05), and the correlation between DD level and CE type was the strongest (OR = 7.660, 95%CI: 4.043 ~ 14.512). The correlation between tHcy level and LAA type was the strongest (OR = 5.078, 95%CI: 2.939 ~ 8.774). Conclusion The levels of plasma DD and tHcy may be the independent risk factors for the occurrence of ACI, and their expression levels are different in different types of ACI. The level of DD is the most obvious in patients with CE type, and the level of tHcy is the most obvious in patients with LAA type. It plays an important role in the etiological diagnosis of ACI.