凝血指标联合D-二聚体检测在不同类型脑卒中鉴别诊断中的价值  

Diagnostic value of coagulation combined with D-dimer in different types of cerebral stroke

作　　者：曾义 王曦 黄忠[1] 赵戈[1] 马中锐[1] 

机构地区：[1]成都市第五人民医院神经内科,611130 [2]成都市第五人民医院内分泌科,611130

出　　处：《临床合理用药杂志》2018年第4期17-19,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的分析凝血指标联合D-二聚体检测在不同类型脑卒中鉴别诊断中的价值。方法选择医院2015年3月-2017年2月收治的脑梗死患者100例(CI组)和脑出血患者100例(CH组),另选择健康者100例(CO组),检测3组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)和D-二聚体,采用受试者工作曲线(ROC)和支持向量机(SVM)分析其对不同类型脑卒中的诊断价值。结果 CI组APTT低于CO组,D-二聚体高于CO组;CH组APTT和D-二聚体均高于CO组;且CI组APTT、TT均低于CH组,D-二聚体高于CH组,差异均有统计学意义(P<0.05)。ROC曲线分析可知,APTT、TT和D-二聚体对于区分CI和CH的曲线下面积分别为0.74、0.64、0.70,敏感性分别为0.78、0.65、0.69,特异性分别为0.67、0.80、0.60,截断值分别为32.44、14.58、2.80。SVM分析可知,APTT、TT和D-二聚体联合检测对于区分CI和CH的敏感性和特异性分别为0.82和0.73。结论凝血指标联合D-二聚体检测可用于CI和CH的辅助鉴别诊断。Objective To evaluate the combination of blood coagulation index and plasma D-dimmer for differencing patients with cerebral infarction（ CI） or cerebral hemorrhage（ CH）. Methods 100 patients with CI（ CI group）,100 patients with CH（ CH group）,and 100 healthy controls（ CO group） were selected,prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ Fib）,thrombin time（ TT） and D-dimer were measured,ROC and support vector machine（ SVM） to analyze the diagnostic value of different types of stroke. Results APTT of CI group was lower than that of CO group,D-dimer was higher than that of CO group; APTT and D-dimer of CH group were higher than those in of CO group; APTT and TT of CI group were lower than those of CH group,D-dimer was higher than CH group,the differences were statistically significant（ P 0. 05）. ROC curve analysis shows that the area under the curve of APTT,TT and D-dimer for distinguishing between CI and CH were 0. 74,0. 64,0. 70,sensitivity were 0. 78,0. 65,0. 69,specificity was 0. 67,0. 80,0. 60,cut-off values were 32. 44,14. 58,2. 80. SVM analysis shows that the sensitivity and specificity of the combined detection of APTT,TT and D-dimer for discriminating between CI and CH respectively were 0. 82 and 0. 73. Conclusion Blood coagulation function combined with D-dimer assay can be used to the differential diagnosis of CI and CH.

关 键 词：脑卒中 脑梗死 脑出血 凝血功能 D-二聚体 

分 类 号：R743.3[医药卫生—神经病学与精神病学]