D-二聚体水平及脑血管侧支循环状况与急性脑梗死患者出血性转化的发生风险和严重程度的关系  

Relationships of D-dimer level and cerebrovascular collateral circulation status with onset risk and severity of hemorrhagic transformation in patients with acute cerebral infarction

作　　者：梁朝莹[1] 沈岳飞[2] 覃祖业[1] 颜循金[1] 黄翠艳[1] 李松良 苏丽娜[1] 罗丽蕾[1] 林敏仕 张炜志[1] LIANG Chao-ying;SHEN Yue-fei;QIN Zu-ye;YAN Xun-jin;HUANG Cui-yan;LI Song-liang;SU Li-na;LUO Li-lei;LIN Min-shi;ZHANG Wei-zhi(Department of Neurology,Qinzhou First People′s Hospital,Qinzhou 535000,China;Department of Neurology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西钦州市第一人民医院神经内科,钦州市535000 [2]广西医科大学第一附属医院神经内科,南宁市530021

出　　处：《广西医学》2021年第24期2919-2922,3015,共5页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z20180257,Z2016075);广西医科大学青年科学基金(GXMUYSF201546)。

摘　　要：目的探讨D-二聚体水平及脑血管侧支循环分级与急性脑梗死患者出血性转化(HT)的发生风险和严重程度的关系。方法选取371例急性脑梗死患者作为研究对象,根据头颅影像学检查结果将其分为HT组(n=102)和非HT组(n=269),再根据HT严重程度进一步将HT组分为出血性脑梗死1型(HI1)组(n=39)、出血性脑梗死2型(HI2)组(n=28)、脑实质出血1型(PH1)组(n=21)、脑实质出血2型(PH2)组(n=14)4个亚组。比较HT组与非HT组患者的D-二聚体水平、侧支循环分级,以及不同亚组HT患者间D-二聚体水平。分析D-二聚体水平、侧支循环分级与脑梗死HT严重程度的相关性。结果HT组患者入院时、入院第3天的血清D-二聚体水平均高于非HT组,入院时侧支循环分级差于非HT组(均P<0.05)。HI1组、HI2组、PH1组、PH2型患者在入院时和入院第3天的血清D-二聚体水平比较差异有统计学意义(均P<0.05);血清D-二聚体水平与脑梗死HT程度呈正相关,侧支循环分级与脑梗死HT程度呈负相关(均P<0.05)。结论血清D-二聚体水平越高,脑侧支循环分级越低,急性脑梗死患者HT的发生风险可能越高,且HT程度更严重。监测脑梗死患者D-二聚体动态变化,并结合侧支循环分级状况,或许有助于判断急性脑梗死患者HT的发生风险和严重程度。Objective To explore the relationships of D-dimer level and cerebrovascular collateral circulation grade with the onset risk and severity of hemorrhagic transformation(HT)in patients with acute cerebral infarction.Methods A total of 371 patients with acute cerebral infarction were selected as research subjects,and they were divided into HT group(n=102)and non-HT group(n=269)according to the results of imaging examination of the head.According to the severity of HT,the HT group was further divided into four subgroups:hemorrhagic cerebral infarction type 1(HI1)group(n=39),hemorrhagic cerebral infarction type 2(HI2)group(n=28),cerebral parenchymal hematoma type 1(PH1)group(n=21)and cerebral parenchymal hematoma type 2(PH2)group(n=14).D-dimer level and collateral circulation grade were compared between the HT group and the non-HT group,and D-dimer level was compared between HT patients in different subgroups.The correlation of D-dimer level or collateral circulation grade with HT severity was analyzed in cerebral infarction.Results Patients in the HT group exhibited higher serum D-dimer levels on admission and on the 3rd day after admission,together with poorer collateral circulation grade on admission,as compared with the non-HT group(all P<0.05).There were statistically significant differences in the serum D-dimer levels on admission and on the 3rd day after admission among the HI1 group,the HI2 group,the PH1 group and the PH2 group(all P<0.05).Serum D-dimer level positively correlated with HT severity in cerebral infarction,and collateral circulation grade negatively correlated with HT severity in cerebral infarction(all P<0.05).Conclusion In patients with acute cerebral infarction,the higher the serum D-dimer level or the lower the grade of cerebral collateral circulation is,the higher the risk for developing HT might be,and the patients might have a more severe HT.Monitoring the dynamic changes of D-dimer in patients with cerebral infarction in combination with their status of collateral circulation grade might

关 键 词：出血性转化 急性脑梗死 D-二聚体 侧支循环 病情评估 

分 类 号：R743.3[医药卫生—神经病学与精神病学]