摘要
目的探讨急性自发性蛛网膜下腔出血患者血清D-二聚体水平对判断患者疾病严重程度及预后的应用价值。方法采集157例自发性蛛网膜下腔出血入院患者的临床数据，同时测定患者血清中D-二聚体水平。根据蛛网膜下腔出血Hunt—Hess分级判断患者发病时病情严重程度，根据改良Fisher量表对患者脑CT扫描进行评分。患者出院3个月后随访预后情况，根据改良RANKIN量表（mRS评分）将入组患者分为预后不良组（mRS3—5分）和预后良好（mRS1～2分）对照组。结果在157例自发性蛛网膜下腔出血患者中预后不良45例，预后良好112例，预后不良组D-二聚体水平显著高于预后良好组（P〈0．01）。通过Spearman相关分析表明，D-二聚体水平与患者入院Hunt-Hess评分呈正相关（r=0．831，P〈0．01），与患者3个月后mRS预后不良评分呈正相关（r=0．834，P〈0．01）。进一步回归分析提示，D-二聚体水平增高是患者预后不良的独立危险因素（OR=1．011，95％CI：1．007～1．016，P〈0．01）。通过ROC受试者工作曲线分析D-二聚体对患者预后不良的判断能力，ROC曲线下面积为0．964（95％CI：0．93～0．98，P〈0．01），敏感度和特异度分别为88．9％和91．1％，截断点D-二聚体水平为739μg／L。结论急性自发性蛛网膜下腔出血患者血清D-二聚体水平与患者发病时疾病严重程度密切相关，患者血清D-二聚体水平增高是患者预后不良的独立危险因素。
Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subraehnoid hemorrhage. Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected, and the level of D-dimer in elbow vein serum were measured. The severity of the disease was judged by Hunt-Hess classification, and the patients, brain CT scans were scored according to the modified Fisher scale. The patients were followed up for 3 months. Based on the modified RANKIN scale （mRS scale）, patients were divided into unfavorable prognosis group （3≤mRS≤5） and good prognosis control group （1 ≤mRS≤2）. Results In the 157 cases of spontaneous subrachnoid hemorrhage patients, there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group. The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them （P 〈0. 01 ）. By the Spearman correlation analysis, the level of D-direct was positively correlated with Hunt-Hess score （ r = 0. 831, P 〈0. 01 ）, and it was also positively correlated with unfavourable prognosis mRS scale （ r = 0. 834, P 〈0. 01 ）. Furthermore, regression analysis showed that high level of D-direct was an independent risk factor for the poor prognosis of patients （ OR = 1.011, 95% CI： 1. 007 - 1. 016, P 〈 0. 01 ）. Through the receiver operating characteristic curve （ROC） analysis of the D-direct in patients with poor prognosis, the area under ROC curve was 0. 964 （95% CI： 0. 93 - 0. 98, P 〈 0. 01 ） , sensitivity and specificity were 88.9% and 99. 1%, respectively. The cut-off point of D-dimer content was 739 μg/L. Conclusions The level of D-di-mer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases, and high level of D-dimer was an independent risk factor for the prognosis of patients.
出处
《中国医师杂志》
CAS
2017年第11期1641-1644,共4页
Journal of Chinese Physician
基金
辽宁省自然科学基金（201602840）
