摘要
目的 探讨血栓弹力图联合中枢神经特异蛋白(S100-β)与D-二聚体对急性脑梗死(ACI)预后及复发的评估价值.方法 回顾并分析2020年7月—2022年7月于济南市中西医结合医院住院的180例ACI患者的临床资料.治疗1个月后,根据评估预后效果的格拉斯哥预后评分(GOS),将患者分为预后良好组(GOS评分4～5分;65例)和预后不良组(GOS评分1～3分;115例);根据1年内是否复发将患者分为复发组(42例)和未复发组(138例).检测所有患者血栓弹力图参数[包括凝血反应时间(RT)、凝固时间(KT)、凝固角(α角)、最大振幅(MA)]以及S100-β和D-二聚体,比较各组上述指标水平差异;采用Spearman相关性分析对血栓弹力图参数、S100-β、D-二聚体与GOS评分的相关性进行分析.继续随访1年,绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),分析各参数水平变化对ACI患者复发的预测价值.结果 预后良好组的RT、KT水平均显著高于预后不良组,α角、MA、S100-β、D-二聚体水平均显著低于预后不良组[RT(min):5.19±1.21比4.37±0.82;KT(min):1.85±0.37比1.56±0.24;α角(°):60.76±7.12比68.49±8.09;MA(mm):61.34±5.86 比 67.05±6.39;S100-β(mg/L):16.78±2.63 比 19.37±3.51;D-二聚体(mg/L):1.69±0.45比2.31±0.68;均P<0.001].相关性分析显示,α角、MA均与GOS评分呈负相关(r值分别为-0.394、-0.352,均P<0.001),RT、KT、S100-β、D-二聚体与GOS评分均呈正相关(r值分别为0.314、0.388、0.407、0.415,均P<0.001).未复发组的RT、KT水平均显著高于复发组,α角、MA、S100-β、D-二聚体水平均显著低于复发组[RT(min):6.52±1.26比5.52±1.37;KT(min):2.25±0.63比1.66±0.54;α角(°):56.83±5.44比60.74±6.91;MA(mm):58.27±6.15比63.34±7.55;S100-β(mg/L):14.35±2.32比16.03±2.61;D-二聚体(mg/L):0.98±0.29比1.22±0.37;均P<0.001].ROC曲线分析显示,KT、MA、RT、α角、S100-β、D-二聚体预测ACI复发的AUC分别为0.774、0.638、0.671、0.703、0.833、0.749.结论 血栓弹力图参数和S100-β、D-二聚体水平均与ACI患者病情发展密切相关,且对ACI复发具有一定预测价值.
Abstract
Objective To explore the evaluation value of thrombelastogram combined with central nervous specific protein(S100-β)and D-dimer in prognosis and recurrence of acute cerebral infarction(ACI).Methods The clinical data of 180 ACI patients admitted to Jinan Integrated Traditional Chinese and Western Medicine Hospital from July 2020 to July 2022 were reviewed and analyzed.After one month of treatment,the patients were classified by Glasgow outcome scale(GOS)and all patients were divided into good prognosis group(GOS score of 4-5 points;65 cases)and poor prognosis group(GOS score of 1-3 points;115 cases).The patients were divided into recurrence group(42 cases)and non recurrence group(138 cases)based on whether they experienced recurrence within one year.The levels of thrombelastogram parameters[including reaction time(RT),Kaolin time(KT),coagulation angle(α angle)and maximum amplitude(MA)],S100-β and D-dimer were measured,and the differences of above indicators among different groups were compared.The correlation of thrombelastogram prameters,S100-β,D-dimer and GOS score was analyzed using Spearman correlation analysis.After one-year follow up,the receiver operator characteristic(ROC)curve was drawn,the area under ROC curve(AUC)was calculated,and the predictive value of changes in parameters for recurrence in ACI patients were analyzed.Results The levels of RT and KT in good prognosis group were higher than those in poor prognosis group,and the levels of α angle,MA,S100-β and D-dimer were lower than those in poor prognosis group[RT(min):5.19±1.21 vs.4.37±0.82;KT(min):1.85±0.37 vs.1.56±0.24;α angle(°):60.76±7.12 vs.68.49±8.09;MA(mm):61.34±5.86 vs.67.05±6.39;S100-β(mg/L):16.78±2.63 vs.19.37±3.51;D-dimer(mg/L):1.69±0.45 vs.2.31±0.68;all P<0.001].Correlation analysis showed that α angle and MA were negatively correlated with GOS score(r values were-0.394 and-0.352,both P<0.001),and RT,KT,S100-β and D-dimer were positively correlated with GOS score(r values were 0.314,0.388,0.407 and 0.415,all P<0.001).The levels of RT and KT in non recurrent group were higher than those in recurrent group,and the levels of α angle,MA,S100-β and D-dimer were lower than those in recurrent group[RT(min):6.52±1.26 vs.5.52±1.37;KT(min):2.25±0.63 vs.1.66±0.54;α angle(°):56.83±5.44 vs.60.74±6.91;MA(mm):58.27±6.15 vs.63.34±7.55;S100-β(mg/L):14.35±2.32 vs.16.03±2.61;D-dimer(mg/L):0.98±0.29 vs.1.22±0.37;all P<0.001].ROC curve analysis showed that the AUC of KT,MA,RT,α angle,S100-β and D-dimer for predicting ACI recurrence were 0.774,0.638,0.671,0.703,0.833 and 0.749,respectively.Conclusion The levels of thromboelastography parameters,S100-β and D-dimer are closely related to the progression of ACI patients and have certain predictive value for recurrence of ACI.
基金项目
山东省济南市卫生健康委科技计划项目(2023-2-104)
维普
万方数据