摘要
目的研究血浆凝血酶-抗凝血酶复合物(TAT)联合D-二聚体(D-D)监测急性缺血性卒中(AIS)患者病情转归的临床价值。方法前瞻性队列研究。收集2021年7月至2024年5月于天津医科大学总医院收治的AIS患者538例,男306例,女232例,年龄(69.5±11.5)岁,其中小动脉闭塞型147例,大动脉粥样硬化型166例,心源性栓塞型122例,癌症相关型103例。对入组患者进行随访观察,收集患者接受急性期治疗1周后的30 d内数据,以血栓相关脑缺血事件复发为终点事件,起止时间为2021年8月5日至2024年6月19日。在随访期内,有68例患者发生终点事件,包括大动脉粥样硬化型患者14例,心源性栓塞型患者23例,癌症相关型患者31例。用化学发光法和酶联免疫荧光法分别测定血浆中TAT和D-D水平。用受试者工作特征(ROC)曲线分析TAT和D-D对AIS患者30 d随访期内缺血事件复发的预测效能,Kaplan-Meier曲线进行生存分析。结果不同类型AIS患者的血浆TAT和D-D水平差异有统计学意义(P<0.05),癌症相关型高于心源性栓塞型(P<0.05),心源性栓塞型高于大动脉粥样硬化型(P<0.05)。在未复发缺血事件患者中,大动脉粥样硬化型、心源性栓塞型和癌症相关型患者治疗后的血浆TAT和D-D水平均低于治疗前(P<0.05)。在缺血事件复发患者中,大动脉粥样硬化型患者治疗后的血浆D-D水平高于治疗前(P<0.05);心源性栓塞型患者治疗后血浆TAT和D-D水平与治疗前比较,差异均无统计学意义(P>0.05);癌症相关型患者治疗后血浆TAT和D-D水平低于治疗前(P<0.05),但高于未复发组(P<0.05)。ROC曲线显示,治疗后第7天的血浆TAT联合D-D预测AIS患者30 d内缺血事件复发风险的曲线下面积均>0.9(大动脉粥样硬化型0.950,心源性栓塞型0.965,癌症相关型0.907),生存分析显示2项指标均高于临界值的不同类型AIS患者累积不良事件发生率均增高(log-rank χ^(2)分别为93.667、109.266和58.433,P均<0.001)。结论AIS患者血浆TAT和D-D水平变化特征与卒中类型及凝血活化存在关联性,动态监测2项指标有助于评估治疗效果,并可预测复发缺血事件风险。
ObjectiveTo explore the prognostic value of assessing plasma thrombin-antithrombin complex(TAT)and D-dimer(D-D)in patients with acute ischemic stroke(AIS).MethodsThis prospective cohort study enrolled 538 AIS patients admitted to the General Hospital of Tianjin Medical University from July 2021 to May 2024,including 306 males and 232 females,with an average age of(69.5±11.5)years.Among them,there were 147 cases of lacunar infarction,166 cases of large artery atherosclerosis type,122 cases of cardioembolic type,and 103 cases of cancer-related type.Follow-up observations were conducted on enrolled patients,data within 30 days after the initiation of acute phase treatment for one week were collected,thrombus-related cerebral ischemic events recurrence served as the endpoint event,starting from August 5,2021,to June 19,2024.During the follow-up period,68 patients experienced endpoint events,including 14 cases of large artery atherosclerosis type,23 cases of cardioembolic type,and 31 cases of cancer-related type.The plasma levels of TAT and D-D were determined by chemiluminescence method and enzyme-linked immunofluorescence assay respectively.The receiver operating characteristic(ROC)curve was used to analyze the prediction performance of TAT and D-dimer for recurrent ischemic events in AIS patients during the 30-day follow-up period,and the Kaplan-Meier curve was used for survival analysis.ResultsStatistically differences were observed in the plasma TAT and D-D levels among patients with different types of AIS(P<0.05),with cancer-related type had higher levels than cardioembolic type(P<0.05),and cardioembolic type had higher levels than large artery atherosclerosis type(P<0.05).In the non-recurrent ischemic event group,the plasma TAT and D-D levels of patients with large artery atherosclerosis type,cardioembolic type and cancer-related type were lower in post-treatment than pre-treatment(P<0.05).In the recurrent ischemic event group,the plasma D-D levels were higher in post-treatment than pre-treatment in the patients with large artery atherosclerosis type(P<0.05);there was no statistically difference between the post-treatment and pre-treatment in plasma TAT and D-D levels in patients with cardioembolic type(P>0.05);in patients with cancer-related type,the TAT and D-D levels were lower in post-treatment than pre-treatment(P<0.05),but higher than those in the non-recurrence group(P<0.05).The ROC curve showed that the area under the curve for predicting the risk of ischemic event recurrence within 30 days in AIS patients by plasma TAT combined with D-D on day 7 after treatment was all>0.9(0.950 for large artery atherosclerosis type,0.965 for cardioembolic type,and 0.907 for cancer-related types).Survival analysis indicated that various patients with both indicators above the critical value had an increased cumulative risk probability of adverse events(log-rank χ^(2)=93.667,109.266,and 58.433,respectively,with all P<0.001).ConclusionThe changes of plasma TAT and D-D levels in AIS patients are associated with stroke type and coagulation activation,and dynamic monitoring of these two indicators could help evaluate the treatment effect and predict the risk of recurrent ischemic events.
作者
赵晓静
党琳
门剑龙
张鸿艳
张珠博
任静
Zhao Xiaojing;Dang Lin;Men Jianlong;Zhang Hongyan;Zhang Zhubo;Ren Jing(Precision Medicine Center,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《中华检验医学杂志》
北大核心
2025年第8期999-1007,共9页
Chinese Journal of Laboratory Medicine
基金
天津市应用基础研究项目(22JCQNJC00330)。
