D-二聚体预测大动脉粥样硬化型卒中近期复发的价值研究

The value of D-dimer in predicting the short-term recurrence of acute ischemic stroke

目的探讨D-二聚体预测大动脉粥样硬化型卒中(LAA)近期复发的价值。方法连续收集2014年1月—2022年6月收治的325例初发LAA患者的临床资料,根据1年内复发情况将患者分为复发组84例和未复发组241例,比较2组临床资料和血清学指标,应用logistic回归分析影响LAA近期复发的因素,应用ROC曲线分析血清学指标预测复发的价值,应用Kaplan-Meier生存曲线分析复发情况。结果复发组高血压比例、保守治疗比例、LDL-C、纤维蛋白原、D-二聚体水平高于未复发组(P<0.05),规律服用他汀类药物比例、规律服用抗血小板药物比例低于未复发组(P<0.05)。Logistic回归分析显示,高血压、规律服用他汀类药物、规律服用抗血小板药物、LDL-C、纤维蛋白原、D-二聚体是影响LAA近期复发的主要因素(P<0.05),治疗方式与LAA近期复发无关(P>0.05);LDL-C、纤维蛋白原、D-二聚体预测LAA近期复发的AUC分别为0.652、0.685、0.787;高LDL-C组、高纤维蛋白原组、高D-二聚体组患者1年复发率高于低LDL-C组、低纤维蛋白原组、低D-二聚体组(P<0.05)。结论D-二聚体水平与ATCI短期预后关系密切,高水平D-二聚体提示近期复发风险较高,应及早进行干预。

Objective This paper aims to investigate the value of D-dimer in predicting short-term recurrence of large-artery atherosclerosis(LAA).Methods The clinical data of 325 patients with initial acute ischemic stroke admitted from January 2014 to June 2022 were retrospectively analyzed.The patients were divided into the recurrence group(n=84)and the non-recurrence group(n=241)according to their recurrence within 1 year.The clinical data and serological indicators of the two groups were compared.Logistic regression was used to analyze the factors influencing the recurrence of LAA,and Kaplan-Meier survival curve was used to analyze the recurrence.Results The hypertension proportion,proportion of conservative treatment,LDL-C,fibrinogen and D-dimer in recurrent group were higher than those in non-recurrent group(P<0.05),and the proportion of regular use of statins and regular use of antiplatelet drugs were lower than those in non-recurrent group(P<0.05).Logistic regression analysis showed that hypertension,regular use of statins,regular use of antiplatelet drugs,LDL-C and fibrinogen and D-dimer were the main factors affecting the recurrence of stroke(P<0.05),while treatment modalities had no relationship with the recurrence of stroke(P>0.05).The AUC of LDL-C,fibrinogen and D-dimer in predicting the recurrence of LAA was 0.652,0.685 and 0.787,respectively.The 1-year recurrence rate of patients in high LDL-C group,high fibrinogen group and high D-dimer group was higher than that in low LDL-C group,low fibrinogen group and low D-dimer group(P<0.05).Conclusion The level of D-dimer is closely related to the short-term prognosis of ATCI,and high levels of D-dimer indicate a high risk of near-term recurrence,requiring early intervention.