血浆D-二聚体水平对急性缺血性脑卒中颅内动脉粥样硬化性大血管闭塞的预测价值  

The predictive value of plasma D-dimer level for acute intracranial atherosclerotic large vessel occlusion in acute ischemic stroke

作　　者：潘晓虎 朱发勇 邱凯 施海彬[2] 刘圣[2] PAN Xiaohu;ZHU Fayong;QIU Kai;SHI Haibin;LIU Sheng(Department of Neurology,Xuyi County People’s Hospital,Huai’an,Jiangsu Province 211700,China)

机构地区：[1]盱眙县人民医院神经内科,江苏淮安211700 [2]南京医科大学第一附属医院介入放射科

出　　处：《介入放射学杂志》2023年第1期9-13,共5页Journal of Interventional Radiology

摘　　要：目的评价血浆D-二聚体水平对接受脑动脉再通治疗的急性缺血性脑卒中(AIS)患者血管闭塞类型的预测价值。方法回顾性分析2019年1月至2020年8月于南京医科大学第一附属医院接受脑动脉再通治疗的AIS患者临床资料。根据术中血管造影结果,将患者分为急性颅内动脉粥样硬化性狭窄(ICAS)所致大血管闭塞(LVO)(ICAS-LVO组)和非ICAS所致LVO(非ICAS-LVO组)。所有患者均在到达急诊时接受血样采集,检测D-二聚体(D-D)水平。采用单因素和多因素logistic回归分析确定ICAS-LVO相关预测因子,与D-D相关性;受试者工作特征曲线(ROC)评价D-D水平预测ICAS-LVO的价值。结果共纳入273例患者。其中79例(28.9%)患者诊断为ICAS-LVO。与非ICAS-LVO组患者相比,ICAS-LVO组患者更年轻,男性比例更高,有吸烟史者更多,伴心房颤动更少,美国国立卫生研究院卒中量表(NIHSS)评分基线值更低(均P<0.05)。ICAS-LVO组患者血浆D-D水平显著低于非ICAS-LVO组患者(0.39 mg/L比1.20 mg/L,P<0.01)。多因素logistic回归分析显示,较低D-D与ICAS-LVO呈显著正相关(OR=0.30,95%CI=0.18~0.47,P<0.01)。基于ROC,血浆D-D预测ICAS-LVO的最佳临界值为0.84 mg/L,灵敏度为84.8%,特异度为67.5%,阴性预测值为91.6%,曲线下面积(AUC)为0.830。结论基线低D-D水平是ICAS-LVO的独立预测因子,有助于神经介入医师预先制定血管再通治疗策略。Objective To evaluate the plasma D-dimer(D-D)levels in predicting the type of vascular occlusion in patients with acute ischemic stroke(AIS)after receiving cerebral artery recanalization treatment.MethodsThe clinical data of patients with AIS,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China between January 2019 and August 2020,were retrospectively analyzed.Based on intraoperative angiographic findings,the patients were classified into large vessel occlusion(LVO)due to acute intracranial atherosclerotic stenosis(ICAS)group(ICAS-LVO group)and large vessel occlusion(LVO)not due to acute intracranial atherosclerotic stenosis(ICAS)group(non-ICAS-LVO group).Blood sampling at emergency room was conducted in all patients to determine the D-D levels.Univariate analysis and multivariate logistic regression analysis were used to identify the ICAS-LVO-associated predictor and to evaluate its relationship to the D-D level.Receiver operating curve(ROC)was used to assess the value of D-D level in predicting ICAS-LVO.ResultsA total of 273 patients were enrolled in this study.Among them,79 patients(28.9%)was diagnosed as ICAS-LVO.Compared with non-ICAS-LVO group,in ICAS-LVO group the patients were younger,the proportion of males was higher,more patients had a history of smoking,less patients had atrial fibrillation,and the National Institutes of Health Stroke Scale(NIHSS)baseline score was even lower(all P<0.05).The plasma D-D level in the ICAS-LVO group was 0.39 mg/L,which was significantly lower than 1.20 mg/L in the non-ICAS-LVO group(P<0.01).Multivariate logistic regression analysis showed that lower D-D level was positively correlated with ICAS-LVO(OR=0.30,95%CI=0.18-0.47,P<0.01).Based on ROC curve,the optimal cut-off value of D-D level for predicting ICAS-LVO was 0.84 mg/L,the sensitivity was 84.8%,the specificity was 67.5%,the negative predictive value was 91.6%,and the area under the curve(AUC)was 0.830.ConclusionLow baseline D-D level is an independent predictor for ICAS-LVO,which

关 键 词：D-二聚体 急性缺血性脑卒中 大血管闭塞 动脉粥样硬化 脑卒中分型 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]