D-二聚体对急性缺血性脑卒中患者rt-PA静脉溶栓后评估早期神经功能与预后效果的研究

Evaluation of early neurological function and prognosis by detecting D-dimer expression after intravenous thrombolysis of RT-PA in patients with acute ischemic stroke

目的研究急性缺血性脑卒中患者应用重组组织型纤溶酶原激活剂(recombinant tissue-plasminogen activator,rt-PA)静脉溶栓后检测D-二聚体表达评估早期神经功能与预后效果。方法选取2020年5月—2021年5月平顶山市第二人民医院接受rt-PA静脉溶栓的急性缺血性脑卒中患者60例,依据溶栓前与溶栓治疗5 d后的NIHSS评分差值(ΔNIHSS)分组,神经功能改善良好(ΔNIHSS≥4分)的47例作为对照组,神经功能改善不良(ΔNIHSS<4分)13例作为研究组,两组患者均开展D-二聚体水平检测,分析该指标与患者神经功能和预后效果之间的关系。结果研究组患者入院时间的NIHSS评分与对照组相比明显降低,而溶栓治疗5 d后,研究组的D-二聚体表达水平明显高于对照组(P<0.05);经多因素logistic回归分析显示,D-二聚体是影响患者神经功能改善与预后效果的独立危险因素,P<0.05;治疗3个月后,52例未发生预后不良,8例发生预后不良,预后不良的发生率为13.33%,预后不良者的D-二聚体显著高于未发生预后不良者,差异有统计学意义(P<0.05)。结论D-二聚体指标是影响rt-PA静脉溶栓治疗后急性缺血性脑卒中患者神经功能改善的高风险因素,D-二聚体表达越高则患者预后效果可能越差,可以为临床预后预测提供重要参考。

Objective To evaluate the early neurological function and prognosis of acute ischemic stroke patients after intravenous thrombolytic therapy with recombinant tissue-plasminogen activator(rt-PA)and D-dimer expression.Methods Sixty patients with acute ischemic stroke who received intravenous thrombolytic therapy with rt-PA in the Second People's Hospital of Pingdingshan City from May 2020 to May 2021 were selected and divided into groups according to the difference of NIHSS score(ΔNIHSS)before and 5 days after thrombolytic therapy.47 patients with good neurological function improvement(ΔNIHSS≥4 points)were selected as the control group.A total of 13 patients with poor neurological function improvement(ΔNIHSS<4 points)were studied.D-dimer level was detected in both groups to analyze the relationship between this index and neurological function and prognosis.Results The NIHSS score of the study group was significantly lower than that of the control group,and the expression level of D-dimer in the study group was significantly higher than that of the control group 5 days after thrombolysis(P<0.05);Multiple logistic regression analysis showed that D-dimer was an independent risk factor affecting the improvement of neurological function and prognosis of patients,P<0.05.After 3 months of treatment,52 cases had no adverse prognosis,and 8 cases had adverse prognosis,the incidence of adverse prognosis was 13.33%,and the D-dimer of the poor prognosis patients was significantly higher than that of the poor prognosis patients,the difference was statistically significant(P<0.05).Conclusion D-dimer index is a high risk factor affecting the improvement of neurological function in patients with acute ischemic stroke after intravenous thrombolytic therapy with RT-PA.The higher the expression of D-dimer,the worse the prognosis of patients may be,which can provide an important reference for clinical prognosis prediction of patients.