血浆D-二聚体水平与急性缺血性脑卒中病因分型、严重程度及预后的相关性研究

The relationship between plasma D-dimer levels and etiological classification,severity and outcome of acute ischemic stroke

目的探究血浆D-二聚体水平与急性缺血性脑卒中的病因分型、严重程度及临床功能预后的相关性。方法回顾性分析2013年1月至2020年12月在北京协和医院住院并经临床和影像学证实为急性缺血性脑卒中患者的临床、影像及实验室资料。结果经临床和影像确诊急性缺血性脑卒中患者共1034例,其中845例患者24 h内完成了血浆D-二聚体水平检测。急性缺血性脑卒中不同病因分型患者血浆D-二聚体水平显著不同(P<0.001)。血浆D-二聚体水平与急性期NIHSS评分(r=0.166,P<0.001)及出院时mRS(r=0.125,P<0.001)呈正相关。二元回归分析显示血浆D-二聚体水平与出院时功能预后不良相关(未经调整OR=1.058,95%CI 1.019~1.099;调整不含NIHSS评分在内混杂因素OR=1.026,95%CI 1.014~1.091;调整含NIHSS评分在内混杂因素OR=1.022,95%CI 0.984~1.061)。NIHSS评分在血浆D-二聚体水平与功能预后不良之间起完全中介作用。血浆D-二聚体水平预测功能预后不良敏感性为54.9%,特异性为66.1%,受试者操作特征(ROC)曲线下面积为0.609。结论血浆D-二聚体水平与急性缺血性脑卒中病因分型及急性期严重程度显著相关,并可能通过此相关性从而影响功能预后。血浆D-二聚体水平可用于预测缺血性脑卒中病因及急性缺血性脑卒中功能预后不良。

Objective To investigate the correlation between plasma D-dimer and subtype,severity and functional prognosis of patients with acute ischemic stroke.Methods The clinical,imaging and laboratory data of patients with acute ischemic stroke were confirmed by clinical and imaging in Peking Union Medical College Hospital from January 2013 to December 2020 were analyzed retrospectively.Results There were 1034 patients with acute ischemic stroke confirmed by clinical and imaging,of which 845 patients completed the detection of plasma D-dimer level within 24 hours and were included in this study.Plasma D-dimer levels was significantly different in different stroke subtypes(P<0.001).Plasma D-dimer levels was positively correlated with NIHSS score(r=0.166,P<0.001)and mRS score(r=0.125,P<0.001).Binary regression analysis showed that plasma D-dimer level was associated with poor functional prognosis(unadjusted OR=1.058,95%CI 1.019~1.099;adjusted model 1 OR=1.026,95%CI 1.014~1.091;adjusted model 2 OR=1.022,95%CI 0.984~1.061).NIHSS score played a full mediation effect between plasma D-dimer level and poor functional prognosis.The sensitivity of plasma D-dimer levels in predicting the prognosis of poor functional prognosis was 54.9%,the specificity was 66.1%,and the area under the receiver operating characteristic(ROC)curve was 0.609.Conclusion We had shown that plasma D-dimer levels are significantly correlated with the etiological classification and severity of acute ischemic stroke,and plasma D-dimer levels may affect the functional prognosis through this correlation.In addition,plasma D-dimer levels can be used to predict poor functional prognosis of acute ischemic stroke.