凝血指标和炎症指标联合检测对缺血性脑卒中患者的应用价值

Application value of combined detection of coagulation and inflammatory indicators in patients with ischemic stroke

目的探讨凝血指标和血常规炎症指标对缺血性脑卒中(IS)患者的临床应用价值。方法选择2022年5月—2023年7月在广州医科大学附属中医医院卒中中心经急诊绿色通道收治的60例IS患者和同期55例健康体检者作为研究对象,分别纳入IS组和对照组。检测所有研究对象的凝血指标[D-二聚体、D-二聚体与纤维蛋白原比值(DFR)]和血常规炎症指标[中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)],比较两组上述指标的水平差异;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),分析各指标单独与联合检测对IS的诊断价值。结果IS组的D-二聚体、DFR、NLR、PLR水平均明显高于对照组[D-二聚体(mg/L):0.34(0.19,0.73)比0.23(0.15,0.32);DFR:0.102(0.063,0.259)比0.078(0.048,0.101);NLR:6.52±6.64比1.81±0.61;PLR:180.54±122.86比116.33±33.25;均P<0.05]。D-二聚体、DFR、NLR、PLR单独与联合检测诊断IS的AUC分别为0.698、0.657、0.868、0.673、0.942,其中联合检测的AUC最大,且敏感度和特异度均较高,分别为90.0%、89.1%。结论D-二聚体、DFR、NLR、PLR水平在IS患者中均明显升高。相较于单独应用,各指标联合应用的诊断价值最高,可作为IS患者早期辅助诊断的标志物。

Objective To investigate the clinical application value of coagulation and inflammatory indicators in patients with ischemic stroke(IS).Methods The 60 patients with IS admitted to the Stroke Center of the Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University through the emergency green channel from May 2022 to July 2023 and 55 healthy physical examiners during the same period were selected as reasearch objects and included into IS group and control group,respectively.The coagulation indicators[D-dimer and D-dimer to fibrinogen ratio(DFR)]and blood routine inflammation indicators[neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)]of all research objects were detected,and the differences of the levels of above indicators between the two groups were compared.The receiver operator characteristic(ROC)curve was drawn,the area under ROC curve(AUC)was calculated,and the diagnostic value of individual and combined detection of each indicator for IS was analyzed.Results The levels of D-dimer,DFR,NLR and PLR in IS group were significantly higher than those in control group[D-dimer(mg/L):0.34(0.19,0.73)vs.0.23(0.15,0.32);DFR:0.102(0.063,0.259)vs.0.078(0.048,0.101);NLR:6.52±6.64 vs.1.81±0.61;PLR:180.54±122.86 vs.116.33±33.25;all P<0.05].The AUC of D-dimer,DFR,NLR,PLR detected alone and in combination for diagnosing IS were 0.698,0.657,0.868,0.673 and 0.942,respectively.Among them,the AUC used in combination was the highest,with high sensitivity and specificity,reaching 90.0%and 89.1%,respectively.Conclusions The levels of D-dimer,DFR,NLR and PLR were significantly increased in patients with IS.Compared with single indicators,the combined detection of D-dimer,DFR,NLR and PLR has the greatest diagnostic value and may be used as a marker for early auxiliary diagnosis of patients with IS.