D-二聚体值>5 mg/mL的急性缺血性脑卒中患者临床特点分析

Clinical features of acute ischemic stroke patients with a D-dimer level of>5 mg/mL

目的分析并总结D-二聚体(DD)值>5 mg/mL的急性缺血性脑卒中患者临床特点。方法纳入我院2016年1月至2018年9月因急性缺血性脑卒中住院,D-二聚体检查次数≥2次,且至少有一次DD值>5 mg/mL的患者,同时采集患者的临床资料。入组患者分为如下亚组比较:一次DD值>5 mg/mL(DD1组,26例)和两次及以上DD值>5 mg/mL(DD2组,39例);明确肿瘤组(14例)和未明确肿瘤组(51例)。结果共入选65例患者,男性30例(46.2%),年龄46~87岁,平均年龄68.7岁。低蛋白血症35例(53.8%),贫血30例(46.2%),明确肿瘤14例(21.5%),预后不良13例(20.0%)。除肿瘤外,导致DD升高的明确原因还包括感染性心内膜炎、肺栓塞、下肢静脉血栓、酸中毒、大面积烫伤、股骨颈骨折等。DD1组与DD2组比较,在DD值、白蛋白量、低蛋白血症、肿瘤标志物怀疑肿瘤的比例等差异有统计学意义(P<0.05)。明确肿瘤组中血红蛋白量,性别、贫血、危险因素个数、肿瘤标志物怀疑肿瘤、预后不良比例与未明确肿瘤组比较,差异有统计学意义(P<0.05)。结论恶性肿瘤是导致脑梗死患者DD增高的首位明确病因,肿瘤与非肿瘤原因导致的高凝状态间存在明显差异。

Objective To investigate the clinical features of acute ischemic stroke patients with a D-dimer(DD)level of>5 mg/mL.Methods The patients who were hospitalized in our hospital due to acute ischemic stroke from January 2016 to September 2018 were enrolled,and all patients underwent at least two times of DD measurement and had a DD level of>5 mg/mL in at least one measurement.Related clinical data were also collected.The patients were divided into the following subgroups for comparison:one-time DD>5 mg/mL group(DD1 group with 26 patients)and two or more times of DD>5 mg/mL group(DD2 group with 39 patients);tumor group(14 patients)and undefined tumorgroup(51 patients).Results A total of 65 patients were enrolled,among whom 30(46.2%)were male patients;the patients'age ranged from 46-87 years,with a mean age of 68.7 years.Among these patients,35(53.8%)had hypoproteinemia,30(46.2%)had anemia,14(21.5%)were diagnosed with tumor,and 13(20%)had poor prognosis.Besides cancer,the definite causes of DD elevation included infective endocarditis,pulmonary embolism,lower extremity venous thrombosis,acidosis,extensive scalds,and femoral neck fracture.There were significant differences between the DD1 group and the DD2 group in DD level,albumin level,hypoproteinemia,and the proportion of patients with suspected tumor markers(P<0.05).There were also significant differences between the tumor group and the undefined tumor group in hemoglobin,sex,anemia,number of risk factors,suspected tumor markers,and the proportion of patients with poor prognosis(P<0.05).Conclusions Malignant tumor is still the most important cause of DD elevation in patients with acute cerebral infarction,andthere is a significant difference between hypercoagulable state due to tumor and non-tumor causes.