rt-PA静脉溶栓前基线NIHSS评分、D-二聚体水平对急性脑梗死患者预后的预测价值

Predictive value of baseline NIHSS score and D-dimer before intravenous thrombolysis in patients with acute cerebral infarction

目的:探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓前基线NIHSS评分及血浆D-二聚体水平对急性脑梗死患者预后的预测价值。方法:选取某院卒中病区经rt-PA静脉溶栓治疗的急性脑梗死患者166例,根据发病后90 d的改良Rankin评分量表(mRS)评估后分为预后良好组38例(mRS≤2分)和预后不良组128例(mRS>2分)。采用单因素及多因素分析急性脑梗死患者静脉溶栓预后的影响因素,绘制受检者ROC曲线来评价基线NIHSS评分、D-二聚体水平对脑梗死患者的预测价值。结果:单因素分析显示预后不良组患者的平均年龄、基线NIHSS评分、D-二聚体水平及房颤患病率[(72.61±10.84)岁、(12.63±5.20)分、0.73(0.35,1.49)mg/L、(31.58)%]均高于预后良好组[(66.61±11.08)岁、(6.94±4.53)分、0.30(0.13,0.61)mg/L、(13.28)%](P<0.05),而血小板计数[(191.87±47.88)×109/L]小于预后良好组[(213.55±54.25)×109/L](P<0.05);Logistics多因素分析得出基线NIHSS评分、血浆D-二聚体水平是影响患者预后的独立危险因素,基线NIHSS评分、D-二聚体ROC曲线结果分别为0.818和0.736,最佳临界值分别为8.5和0.518,灵敏度和特异度分别为76.30%、74.2%和68.4%、71.1%。结论:rt-PA静脉溶栓前基线NIHSS评分、血浆D-二聚体水平对急性脑梗死患者预后有一定的预测价值。

Objective:To investigate the prognostic value of baseline NIHSS score and plasma D-dimer in patients with acute cerebral infarction before intravenous thrombolysis with rt-PA.Methods:A total of 166 patients with acute cerebral infarction who received intravenous thrombolytic therapy with rt-PA in a hospital were selected.According to the follow-up score of modified Rankin Score Scale(mRS)90 days after onset,they were divided into a good prognosis group(mRS≤2 points,N=38)and a poor prognosis group(mRS>2 points,N=128).Clinical data of the two groups were compared.Blood test data included age,sex,history of hypertension,smoking and drinking,time of onset,time from admission to intravenous thrombolysis(DNT),National Institutes of Health Stroke Scale(NIHSS)score at admission(baseline NIHSS score),plasma D-dimer level before thrombolysis and other blood test data.Results:Clinical data of the patients were analyzed by univariate comparison.The results showed that the mean age,baseline NIHSS score,D-dimer level and incidence of atrial fibrillation in the poor prognosis group were[(72.61±10.84)years,(12.63±5.20)points,0.73(0.35,1.49)mg/L,(31.58)%],higher than those in the good prognosis group[(66.61±11.08)years,(6.94±4.53)points,0.30(0.13,0.61)mg/L,(13.28)%],the differences being statistically significant(P<0.05).According to logistics analysis,baseline NIHSS score and plasma D-dimer level were the risk factors affecting the prognosis of patients.Conclusion:Baseline NIHSS score and plasma D-dimer level before rt-PA intravenous thrombolysis are independent risk factors for prognosis of patients with acute cerebral infarction.