血清D-二聚体与急性缺血性脑卒中患者rt-PA静脉溶栓后早期神经功能改善及预后的关系  

Analysis of the relationship between serum D-dimer and early neurological improvement and prognosis after rt-PA intravenous thrombolysis in patients with acute ischemic stroke

作　　者：黄晶 刘颖[2] 吴正刚[2] 黄玉静[2] 丁鸭锁 HUANG Jing;LIU Yin;WU Zhenggang;HUANG Yujing;DING Yasuo(Medical College,Yangzhou University,Yangzhou 225000,China;Department of Neurology,Taizhou People's Hospital,Yangzhou 225300,China)

机构地区：[1]扬州大学医学院,江苏扬州225000 [2]泰州市人民医院神经内科,江苏泰州225300

出　　处：《中国实用神经疾病杂志》2019年第8期830-835,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的 分析经重组组织型纤溶酶原激活剂(rt-PA)治疗后的急性缺血性脑卒中(AIS)患者血清D二聚体水平与神经功能改善及预后的关系。方法 选取2016-01-2018-10泰州市人民医院收治的114例AIS患者,根据rt-PA治疗5d后美国国立卫生研究院卒中量表(NIHSS)评分较溶栓前的差值(ΔNIHSS)分为神经功能改善良好组(ΔNIHSS≥4分)和神经功能改善不良组(ΔNIHSS<4分),比较2组基础信息、血液生化指标、血压和入院时NIHSS评分等。记录rt-PA治疗后预后不良率,对单因素分析筛选出来可能影响患者早期神经功能改善的因素进一步进行Logistic回归分析,分析血清D二聚体水平与预后不良的关系。结果 89例患者被归为神经功能改善良好组,25例患者被归为神经功能改善不良组,2组糖尿病患病率、年龄、入院时NIHSS得分、空腹血糖、糖化血红蛋白、纤维蛋白原和D二聚体水平差异有统计学意义(P<0.05),多因素Logistic回归分析显示年龄较大、入院NIHSS评分较高和D二聚体水平高是神经功能改善的危险因素(P<0.05)。治疗90d后预后不良者为15例,预后良好者99例,后者的D二聚体显著低于前者,差异有统计学意义(P<0.05)。结论 年龄较大、入院NIHSS评分较高和D二聚体水平高是rt-PA静脉溶栓治疗后神经功能改善的危险因素,血清D二聚体水平可能可以作为预测AIS患者预后的一个重要参考指标。Objective To analyze the relationship between serum D-dimer level and neurological function improvement and prognosis in patients with acute ischemic stroke (AIS) after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). Methods From January 2016 to October 2018,114 AIS patients were divided into good neurological improvement group (NIHSS≥4) and poor neurological improvement group (NIHSS<4) according to the difference of NIHSS score between before and after rt-PA thrombolytic therapy 5 days later.The basic information,blood biochemical parameters,blood pressure and NIHSS score at admission were compared between the two groups.The number of patients with poor prognosis after intravenous thrombolysis with rt-PA was recorded.The factors that might affect the early improvement of neurological function were screened out by single factor analysis.Logistic regression analysis was carried out to analyze the relationship between serum D-dimer level and poor prognosis.SPSS 22.0 statistical software was used for statistical analysis. Results 89 patients were classified as the group with good neurological function improvement,25 patients were classified as the group with poor neurological function improvement.There were significant differences in diabetes prevalence,age,NIHSS score at admission,fasting blood sugar,glycosylated hemoglobin,fibrinogen and D-dimer levels between the two groups ( P <0.05).Multivariate logistic regression analysis showed that older patients had higher NIHSS score at admission,higher levels of D-dimer were risk factors for improvement of neurological function ( P <0.05).After 90 days of treatment,15 cases had poor prognosis and 99 cases had good prognosis.The D-dimer of the latter was significantly lower than that of the former ( P <0.05). Conclusion Older age,higher NIHSS score and higher D-dimer level are risk factors for improvement of neurological function after rt-PA intravenous thrombolysis.Serum D-dimer level may be an important prognostic index for AIS patients

关 键 词：重组组织型纤溶酶原激活剂 D-二聚体 急性缺血性脑卒中 危险因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]