出血性和缺血性脑卒中患者凝血、炎症指标水平变化及诊断价值分析

Study on the changes and diagnosis value of coagulation and inflammation indexes in hemorrhagic and ischemic stroke

目的探讨凝血及炎症相关指标在出血性和缺血性脑卒中患者中的水平变化及辅助诊断价值。方法选取2019年9月至2020年9月于首都医科大学附属北京天坛医院就诊的494例脑卒中患者为研究对象,其中出血性脑卒中患者195例,缺血性脑卒中患者299例。分别测定并比较两组凝血指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、D二聚体(D-D)、纤维蛋白原降解产物(FDP)]和炎症指标[超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)]水平变化,并采用受试者工作特征曲线(ROC曲线)分析各类指标对不同类型脑卒中的诊断价值。结果凝血指标分析结果显示,出血性脑卒中患者PT较缺血性脑卒中患者延长,Fib水平低于缺血性脑卒中患者(P<0.05)。炎症指标分析结果显示,出血性脑卒中患者WBC、NLR均高于缺血性脑卒中患者,hs-CRP水平低于缺血性脑卒中患者(P<0.05);两组其余指标之间差异无统计学意义(P>0.05)。ROC曲线分析可知,各指标对鉴别出血性脑卒中和缺血性脑卒中具有一定诊断价值(P<0.05),其中NLR的诊断效能较其他指标高,曲线下面积(AUC)为0.589,灵敏度为62.6%,特异度为55.5%。结论不同类型脑卒中患者PT、Fib、WBC、NLR、hs-CRP水平差异显著,检测上述凝血和炎症指标水平可作为鉴别诊断不同类型脑卒中的参考。

Objective To explore the level changes and auxiliary diagnostic value of coagulation and inflammation related indexes in patients with hemorrhagic and ischemic stroke.Methods A total of 494 stroke patients treated in Beijing Tiantan Hospital,Capital Medical University from September 2019 to September 2020 were selected as the research objects,including 195 patients with hemorrhagic stroke and 299 patients with ischemic stroke.The levels of coagulation indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),D-Dimer(D-D),fibrinogen degradation product(FDP)]and inflammatory indexes[high-sensitivity C-reactive protein(hs-CRP),leukocyte count(WBC),neutrophil lymphocyte ratio(NLR)]were measured and compared between the two groups.Receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of various indexes for different types of stroke.Results The results of coagulation index analysis showed that PT in patients with hemorrhagic stroke was longer than that in patients with ischemic stroke,and the level of FIB was lower than that in patients with ischemic stroke(P<0.05).The results of inflammatory index analysis showed that WBC and NLR in patients with hemorrhagic stroke were higher than those in patients with ischemic stroke,and the level of hs-CRP was lower than that in patients with ischemic stroke(P<0.05),while there was no significant difference in other indexes between the two groups(P>0.05).ROC curve analysis shows that each index had a certain diagnostic value in differentiating hemorrhagic stroke from ischemic stroke.The diagnostic efficacy of NLR was higher than that of other indexes.The area under the curve(AUC)was 0.589,the sensitivity was 62.6%,and the specificity was 55.5%.Conclusion The levels of PT,FIB,WBC,NLR and hs-CRP in patients with different types of stroke are significantly different.The detection of the above coagulation and inflammation indexes could be used as a reference for the differential diagnosis of different types of stroke.