[1]潘晓虎,朱发勇,邱　凯,等.血浆D-二聚体水平对急性缺血性脑卒中颅内动脉粥样硬化性大血管闭塞的预测价值[J].介入放射学杂志,2023,32(01):9-13.
　PAN Xiaohu,ZHU Fayong,QIU Kai,et al.The predictive value of plasma D-dimer level for acute intracranial atherosclerotic large vessel occlusion in acute ischemic stroke[J].journal interventional radiology,2023,32(01):9-13.
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血浆D-二聚体水平对急性缺血性脑卒中颅内动脉粥样硬化性大血管闭塞的预测价值()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
32
期数:
2023年01
页码:
9-13
栏目:
神经介入
出版日期:
2023-02-13

文章信息/Info

Title:
The predictive value of plasma D-dimer level for acute intracranial atherosclerotic large vessel occlusion in acute ischemic stroke
作者:
潘晓虎; 　朱发勇; 　邱　凯; 　施海彬; 　刘　圣
Author(s):
PAN Xiaohu;  ZHU Fayong;  QIU Kai;  SHI Haibin;  LIU Sheng.
Department of Neurology, Xuyi County People’s Hospital, Huai’an, Jiangsu Province 211700, China
关键词:
【关键词】 D-二聚体; 急性缺血性脑卒中; 大血管闭塞; 动脉粥样硬化; 脑卒中分型; 机械取栓
文献标志码:
A
摘要:
【摘要】　目的　评价血浆D-二聚体水平对接受脑动脉再通治疗的急性缺血性脑卒中（AIS）患者血管闭塞类型的预测价值。方法　回顾性分析2019年1月至2020年8月于南京医科大学第一附属医院接受脑动脉再通治疗的AIS患者临床资料。根据术中血管造影结果，将患者分为急性颅内动脉粥样硬化性狭窄（ICAS）所致大血管闭塞（LVO）（ICAS-LVO组）和非ICAS所致LVO（非ICAS-LVO组）。所有患者均在到达急诊时接受血样采集, 检测D-二聚体（D-D）水平。采用单因素和多因素logistic回归分析确定ICAS-LVO相关预测因子，与D-D相关性；受试者工作特征曲线（ROC）评价D-D水平预测ICAS-LVO的价值。结果　共纳入273例患者。其中79例（28.9%）患者诊断为ICAS-LVO。与非ICAS-LVO组患者相比，ICAS-LVO组患者更年轻，男性比例更高，有吸烟史者更多，伴心房颤动更少，美国国立卫生研究院卒中量表（NIHSS）评分基线值更低（均P＜0.05）。ICAS-LVO组患者血浆D-D水平显著低于非ICAS-LVO组患者（0.39 mg/L比1.20 mg/L，P＜0.01）。多因素logistic回归分析显示，较低D-D与ICAS-LVO呈显著正相关（OR=0.30，95%CI=0.18～0.47，P＜0.01）。基于ROC，血浆D-D预测ICAS-LVO的最佳临界值为0.84 mg/L，灵敏度为84.8%，特异度为67.5%，阴性预测值为91.6%，曲线下面积（AUC）为0.830。结论　基线低D-D水平是ICAS-LVO的独立预测因子，有助于神经介入医师预先制定血管再通治疗策略。

参考文献/References:

［1］　Wang W, Jiang B, Sun H, et al. Prevalence,incidence,and mortality of stroke in China: results from a nationwide population-based survey of 480687 adults［J］. Circulation, 2017, 135: 759-771.
［2］　周腾飞，朱良付，李天晓，等. 动脉粥样硬化性和心源性颅内大血管闭塞对血管内治疗反应性差异研究［J］. 中国卒中杂志，2017，12：579-583．
［3］　邓小文，李　斌，韩　婷，等. 不同卒中分型急性基底动脉闭塞机械取栓临床研究［J］. 介入放射学杂志，2020，29：541-545．
［4］　中华医学会神经病学分会. 中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018［J］. 中华神经科杂志，2018，51：683-691．
［5］Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-dimer［J］. J Am CollCardiol, 2017, 70: 2411-2420.
［6］　张　琪，樊凌华. D-二聚体与临床疾病相关性的研究进展［J］. 中国中西医结合急救杂志，2017，24：666-668．
［7］　Lee MJ, Chung JW, Ahn MJ, et al. Hypercoagulability and mortality of patients with stroke and active cancer: the OASIS-CANCER study［J］. J Stroke, 2017, 19: 77-87.
［8］ Ramos-Pachon A, Lopez-Cancio E, Bustamante A, et al. D-dimer as predictor of large vessel occlusion in acute ischemic stroke［J］. Stroke, 2021, 52: 852-858.
［9］　Tsang A, Orru E, Klostranec JM, et al. Thrombectomy outcomes of intracranial atherosclerosis-related occlusions a systematic review and meta-analysis［J］. Stroke, 2019, 50: 1460-1466.
［10］ Zhou TF, Zhu LF, Li TX, et al. Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke［J］. J Interv Med, 2018, 1: 77-81.
［11］ Yang D, Lin M, Wang S, et al. Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion［J］. IntervNeuroradiol, 2018, 24: 412-420.
［12］蒋　珂，潘瑞华. D-二聚体值水平与缺血性脑卒中患者短期预后的相关性［J］. 中国老年学杂志，2022，42：540-543．
［13］ Yoon W, Kim SK, Park MS, et al. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke［J］. Neurosurgery, 2015, 76: 680-686.
［14］Fassbender K, Bertsch T, Mielke O, et al. Adhesion molecules in cerebrovascular diseases. Evidence for an inflammatory endothelial activation in cerebral large-and small-vessel disease［J］.Stroke, 1999, 30: 1647-1650.
［15］ Siegbahn A, Oldgren J, Andersson U, et al. D-dimer and factor VIIa in atrial fibrillation - prognostic values for cardiovascular events and effects of anticoagulation therapy. A RE-LY substudy［J］. ThrombHaemost, 2016, 115: 921-930.
［16］Boeckh-Behrens T, Schubert M, Forschler A, et al. The impact of histological clot composition in embolic stroke［J］. ClinNeuroradiol, 2016, 26: 189-197.
［17］Pikija S, Magdic J, Trkulja V, et al. Intracranial thrombus morphology and composition undergoes time-dependent changes in acute ischemic stroke: a CT densitometry study［J］. Int J Mol Sci,2016,17:1959.
［18］Sgreccia A, Duchmann Z, Desilles JP, et al. Association between acute ischemic stroke etiology and macroscopic aspect of retrieved clots: is a clot’s color a warning light for underlying pathologies?［J］. J NeurointervSurg, 2019, 11: 1197-1200.

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备注/Memo

备注/Memo:
（收稿日期：2022-05-28）
（本文编辑：边　佶）
更新日期/Last Update: 2023-02-13