凝血和纤溶指标在急性脑梗死和非急性脑梗死鉴别诊断中的应用价值  

The Application Value of Fibrinolytic and Coagulation Indexes in DifferentialDiagnosis of Acute Cerebral Infarction and Non-Acute Cerebral Infarction

作　　者：徐佳[1] 张鹏[1] 黄烨[2] 陈贵丹 温雪[1] 王凤梅[1] 刘文娟[1] 王雅平[1] 李琦[1] XU Jia;ZHANG Peng;HUANG Ye;CHEN Guidan;WEN Xue;WANG Fengmei;LIU Wenjuan;WANG Yaping;LI Qi(Department of Clinical Laboratory of Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Emergency of Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Bijie Kingmed for Clinical Laboratory Co,.Ltd,Guizhou Province,Bijie 551601,China)

机构地区：[1]中国中医科学院西苑医院检验科,北京100091 [2]中国中医科学院西苑医院急诊科,北京100091 [3]毕节金域医学检验实验室有限公司,贵州毕节551601

出　　处：《标记免疫分析与临床》2022年第7期1106-1111,共6页Labeled Immunoassays and Clinical Medicine

基　　金：国家重点研发计划(2019YFF0216502)。

摘　　要：目的 研究常见纤溶和凝血指标在急性脑梗死(acute cerebral infarction, ACI)和非急性脑梗死(non acute cerebral infarction, Non-ACI)鉴别诊断中的预测价值。方法 选取2018年10月至2019年10月中国中医科学院西苑医院急诊科收治的100例ACI患者为试验组,另选100例Non-ACI患者为对照组,进行回顾性分析。检测患者入院后48 h内D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen, Fbg)、纤维蛋白原降解产物(fibrinogen degradation products, FDP)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、凝血酶原时间(prothrombin time, PT)、凝血酶时间(thrombin time, TT)和抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)的血浆水平,并计算D-D/Fbg和D-D/FDP比值,分析比较各指标在两组间以及在不同性别和年龄段之间的差异。结果 ACI组中D-D、Fbg、FDP、D-D/Fbg、D-D/FDP和PT的水平明显高于Non-ACI组(P<0.05)。ACI组中,女性患者D-D、FDP、D-D/Fbg和PT水平高于男性患者,而APTT在男性患者中呈现较高水平;>70岁患者D-D、FDP和D-D/Fbg的水平高于≤70岁的患者。在Non-ACI组中,仅男性患者的APTT高于女性患者;>70岁患者D-D、FDP、D-D/Fbg、D-D/FDP和PT的水平均高于≤70岁患者,而AT-Ⅲ则相反(P<0.05)。D-D、FDP、D-D/Fbg、D-D/FDP、PT和Fbg的ROC曲线下面积依次为:0.82、0.79、0.79、0.75、0.64、0.61,其中D-D对预测ACI的灵敏度为95%,特异性为68%。结论 D-D、Fbg、FDP、D-D/Fbg、D-D/FDP和PT在ACI和Non-ACI患者以及不同性别和年龄的ACI患者中存在一定差异,因此对ACI和Non-ACI患者的鉴别诊断有一定价值。Objective The aim of this study was to examine the predictive value of a panel of fibrinolytic and coagulation indexes in differential diagnosis of ACI and Non-ACI.Methods A total of 100 ACI patients admitted to the Emergency Department of Xiyuan Hospital,China Academy of Chinese Medical Sciences,from October,2018 to October,2019 were selected as the experimental group,while 100 non-ACI patients were selected as the control group for a retrospective analysis.Plasma levels of D-D,Fbg,FDP,APTT,PT,TT and AT-Ⅲat admission(<48 hours)were assessed and D-D/Fbg and D-D/FDP ratios were calculated.The differences of test indexes between the two groups and between different genders and age groups were analyzed and compared.Results Levels of D-D,Fbg,FDP,D-D/Fbg,D-D/FDP and PT in the ACI group were higher than those in the Non-ACI group(P<0.05).In the ACI group,levels of D-D,FDP,D-D/Fbg and PT in female patients were higher than those in male patients,and APTT in male patients was higher than female patients;Plasma levels of D-D,FDP and D-D/Fbg in patients over 70 years old were higher than those in patients under 70 years old(including 70 years old).In the Non-ACI group,APTT in male patients was higher than female patients;Plasma levels of D-D,FDP,D-D/Fbg,D-D/FDP and PT in patients over 70 years old were higher than those in patients under 70 years old(including 70 years old),while AT-Ⅲwas the opposite(P<0.05).The area under the ROC curve for D-D,FDP,D-D/Fbg,D-D/FDP,PT and Fbg were in order of:0.82,0.79,0.79,0.75,0.64,and 0.61.D-D had a sensitivity of 95%and a specificity of 68%for predicting ACI.Conclusion There are differences in D-D,Fbg,FDP,D-D/Fbg,D-D/FDP and PT in ACI and Non-ACI patients as well as in ACI patients of different genders and ages,which has a certain value in the differential diagnosis of ACI and Non-ACI patients.

关 键 词：急性脑梗死 纤溶系统 凝血系统 检验指标 

分 类 号：R743.33[医药卫生—神经病学与精神病学]