摘要
目的本研究旨在探索血浆D-二聚体(D-dimer,D-D)对心源性栓塞(cardiogenic embolization,CE)型急性大血管闭塞性脑卒中(acute large vascular occlusion stroke,ALVOS)患者行机械取栓(mechanical thrombectomy,MT)术后预后不良的预测价值分析。方法连续选取2020年1月—2023年3月南京医科大学附属常州第二人民医院接受MT的心源性栓塞(cardioembolism,CE)型ALVOS患者,共158例,回顾性分析其临床基础资料、手术信息及预后情况,比较预后良好组与预后不良组基线资料。采用Logistic回归分析MT术后90 d预后不良的独立危险因素,并应用ROC曲线评估MT术后24 h内的D-D水平对90 d转归不良的预测价值。结果CE型ALVOS患者预后不良组在基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、空腹血糖(fasting plasm glucose,FPG)、D-D水平均显著高于预后良好组,吸烟、饮酒史、症状性颅内出血(symptomatic intracerebral hemorrhage,sICH)及较差的改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级与预后不良正相关。Logistic回归在校正NIHSS评分、吸烟、饮酒、FPG、sICH、mTICI后,发现D-D(OR=2.14,95%CI:2.02~2.27,P<0.05)是CE型ALVOS患者MT术后90 d转归不良的独立危险因素。D-D预测MT术后90 d转归不良的曲线下面积(area under the curve,AUC)为0.708,最佳截断值为0.404,此时敏感度和特异度分别为81.0%和58.5%。结论MT术后24 h内D-D水平升高对预测CE型ALVOS患者90 d预后不良有一定的价值。
Objective To evaluate the predictive value of plasma D-dimer(D-D)in patients with cardioembolism(CE)type acute large vascular occlusion stroke(ALVOS)after mechanical thrombectomy(MT)surgery.Methods A total of 158 patients with CE type ALVOS who received MT in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University from January 2020 to March 2023 were selected.The clinical basic data,surgical information and prognosis were retrospectively analyzed,and the baseline data of the good prognosis group and the poor prognosis group were compared.Logistic regression was used to analyze the independent risk factors for poor prognosis 90 days after MT,and ROC was used to evaluate the predictive value of 90-day poor outcome at D-D level within 24 h after MT.Results The baseline NIHSS score,FPG and D-D levels in CE type ALVOS patients with poor prognosis were significantly higher than those in good outcome group,and history of smoking and drinking,sICH and poor mTICI grade were positively correlated with poor outcome.Multivariate Logistic regression adjusted for NIHSS score,smoking,drinking,FPG,sICH and mTICI found that D-D(OR=2.14,95%CI:2.02-2.27,P<0.05)was an independent risk factor for poor outcome 90 days after MT in patients with CE type ALVOS.D-D predicted that the AUC of poor outcome 90 days after MT was 0.708,the best cut-off value was 0.404,and the sensitivity and specificity were 81.0%and 58.5%,respectively.Conclusion The increase of D-D level within 24 hours after MT operation is of certain value in predicting the poor 90-day prognosis of CE type ALVOS patients.
作者
钱胜男
张敏
张清秀
恽文伟
QIAN Shengnan;ZHANG Min;ZHANG Qingxiu;YUN Wenwei(Department of Neurology,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China;Department of Neurology,Nanjing Gulou Hospital,Nanjing,Jiangsu 210000,China)
出处
《手术电子杂志》
2023年第3期29-34,共6页
Electronic Journal of Medical Operations
基金
南京医科大学常州临床医学中心临床项目(CMCC202207)
江苏省中医药科技发展计划项目(MS2022077)
关键词
大血管闭塞性脑卒中
心源性栓塞
机械取栓
预后
D-二聚体
acute large vascular occlusion stroke
cardioembolism
mechanical thrombectomy
prognosis
D-dimer
