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中华卫生应急电子杂志 ›› 2020, Vol. 06 ›› Issue (06) : 345 -349. doi: 10.3877/cma.j.issn.2095-9133.2020.06.005

所属专题: 文献

论著

外周血D-二聚体和中性粒细胞-淋巴细胞比值快速诊断急性脑梗死患者的价值
徐冬勤1, 何斌2, 刘强晖2, 张劲松2, 李华2,()   
  1. 1. 213000 江苏常州,江苏大学附属武进医院急诊科、徐州医科大学武进临床学院
    2. 210000 江苏南京,南京医科大学第一附属医院急诊医学中心
  • 收稿日期:2019-09-06 出版日期:2020-12-18
  • 通信作者: 李华

D-dimer, neutrophil-lymphocyte ratio in peripheral blood is used for rapid diagnosis and classification of acute cerebral infarction patients

Dongqin Xu1, Bin He2, Qianghui Liu2, Jinsong Zhang2, Hua Li2,()   

  1. 1. Changzhou Wujin People’s Hospital, Wujin Hospital Affiliated to Jiangsu University, Xuzhou Medical University Wujin Clinical Medical College, Changzhou 213000, China
    2. Emergency Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
  • Received:2019-09-06 Published:2020-12-18
  • Corresponding author: Hua Li
  • About author:
    Corresponding author: Li Hua, Email:
引用本文:

徐冬勤, 何斌, 刘强晖, 张劲松, 李华. 外周血D-二聚体和中性粒细胞-淋巴细胞比值快速诊断急性脑梗死患者的价值[J/OL]. 中华卫生应急电子杂志, 2020, 06(06): 345-349.

Dongqin Xu, Bin He, Qianghui Liu, Jinsong Zhang, Hua Li. D-dimer, neutrophil-lymphocyte ratio in peripheral blood is used for rapid diagnosis and classification of acute cerebral infarction patients[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(06): 345-349.

目的

观察不同类肝素药物治疗急性缺血性脑卒中试验(trial of org 10172 in acute stroke treatment,TOAST类型)的急性脑梗死(ACI)患者外周血D-二聚体和中性粒细胞-淋巴细胞比值(NLR)水平的差异,探讨其在ACI快速诊断与病情评估中的临床意义。

方法

分析南京医科大学第一附属医院急诊医学中心2018年3月至2019年3月收治的224例ACI患者(ACI组),以同时期在南京医科大学第一附属医院健康管理中心进行体检的健康人群178例为对照组,采用回顾性病例对照研究,其中男性260例,女性142例;年龄42~ 75岁,平均(58.1±17.2)岁。ACI患者通过头颅电子计算机断层扫描血管造影(CTA)或数字减影血管造影(DSA)明确血管病变,确定其急性卒中治疗Org10172试验亚型( trial of org 10172 in acute stroke treatment,TOAST亚型)[大动脉粥样硬化型(LAA)、小动脉闭塞型(SAO)、心源性栓塞型(CE)、其他明确病因型(SOD)及不明原因型(SUE)]。比较ACI组与对照组以及各TOAST亚型间外周血D-二聚体、中性粒细胞-淋巴细胞比值(NLR)的差异,分析D-二聚体及NLR与急性脑梗死TOAST类型的关系。

结果

ACI组患者的外周血D-二聚体[(1.321±0.690)mg/L比(0.050±0.021)mg/L]和NLR[(4.515±1.693)比(1.722±0.674)]水平显著高于对照组。ACI患者类型包括LAA型(83例)、SAO型(76例)和CE型(65例),其中CE型患者的D-二聚体[(2.858±1.639)mg/L]及NLR(8.128±2.069)水平最高,而LAA型[(1.317±0.172)mg/L,(4.323±1.776)]又均高于SAO型[(0.655±0.672)mg/L,(2.210±1.690)],差异均有统计学意义(P均<0.05)。且ACI患者的外周血D-二聚体水平和NLR呈正相关[r=0.604,95%CI:0.644~8.475 ,P<0.05]。

结论

ACI患者不同TOAST分型间的外周血D-二聚体、NLR水平存在差异,监测其水平变化有助于临床对其进行早期分型和诊断。

Objective

To analyze the difference of d-dimer and neutrophil-lymphocyte ratio (NLR) in peripheral blood of patients with different TOAST types of acute cerebral infarction (ACI), and to explore its clinical significance in the rapid diagnosis and condition assessment of ACI.

Methods

A retrospective case-control study was conducted on 224 patients (ACI group) admitted to the Emergency Medical Center of the First Affiliated Hospital of Nanjing Medical University from March 2018 to March 2019 and 178 healthy people (control group) who underwent physical examination in the Health Management Center of the First Affiliated Hospital of Nanjing Medical University during the same period. ACI patients were subjected to skull computer tomography angiography (CTA) and digital subtraction angiography (DSA) to demonstrate vascular lesions, and to determine the TOAST classification [artery atherosclerosis model (LAA), small artery occlusion model (SAO), cardiac embolism (CE), other type clear etiology (SOD) and unknown causes (SUE)]. The differences of d-dimer and neutrophil-lymphocyte ratio (NLR) in peripheral blood between ACI group and control group and TOAST subtypes were compared to analyze the relationship between d-dime and NLR and TOAST type in acute cerebral infarction.

Results

The levels of d-dimer [(1.321±0.690) mg/L vs. (0.050±0.021) mg/L] and NLR [(4.515±1.693) vs. (1.722±0.674)] in peripheral blood of patients in the ACI group were significantly higher than those in the control group. This research into the type of ACI patients included LAA (83 cases), SAO (76 cases) and CE (65 cases), type of CE in patients with d-dimer [(2.858±1.639 mg/L)] and NLR (8.128 + 2.069), the highest level and LAA type [(1.317 ±0.172)mg/L, (4.323±1.776)] that were higher than SAO type [(0.655±0.672 mg/L), (2.210±1.690)], the differences were statistically significant (P<0.05). In addition, the level of d-dimer in peripheral blood of ACI patients was positively correlated with NLR [r=0.604, 95% confidence interval (CI) : 0.644~8.475, P < 0.05].

Conclusion

There are differences in d-dimer and NLR levels in peripheral blood of ACI patients with different TOAST typing, and monitoring their level changes is helpful for clinical early typing and diagnosis.

表1 对照组和ACI组外周血D-二聚体和NLR水平的比较(±s)
表2 不同TOAST分型的ACI患者外周血D-二聚体和NLR水平的比较
1
Roger VL, Go AS, Lloyd-Jones DM,et al.Heart disease and stroke statistics 2011 update:a report from the american heart association[J].Circulation,2011,123(4): e18-e209.
2
Wang W, Gao C, Yu C,et al. No association between elevated total homocysteine levels and functional outcome in elderly patients with acute cerebral infarction[J].Front Aging Neurosci,2017,9: 70.
3
Wang D, Hu J, Ma Q,et al. Correlation between biochemical indicators of blood lipid with cerebral vascular diseases[J].Int J Clin Exp Pathol,2015,8(3): 3022-3026.
4
吴锐浩,周星星,周武,等.脑梗死与血脂及同型半胱氨酸水平的相关性研究[J].预防医学,2017,29(12): 1231-1234.
5
Wada H, Dohi T, Miyauchi K,et al.Preprocedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease[J].Atherosclerosis,2017,8(18): 35-40.
6
李文华,潘薇.中性粒细胞和淋巴细胞比率与也血管疾病的关系[J].血管病学进展,2014,3(1): 67-70.
7
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. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9): 666-682.
8
Lloyd-Jones D, Adamsr J, Brown TM,et al. Heart disease and stroke statistics-2010 update:a report from the American Heart Association[J].Circulation,2010,121(7): 948-954.
9
李春,赵高峰,何谦益,等.中性粒细胞-淋巴细胞比值与急性脑梗死的相关性分析[J]. 中国实用神经疾病杂志,2018,21(1): 21-25.
10
朱衡亚,胡兴越,马红岗.不同TOAST分型老年脑梗死患者胱抑素C、超敏C反应蛋白及同型半胱氨酸水平变化[J].中国老年学杂志,2015,35(10): 2682-26833.
11
张艳丽.不同TOAST亚型的青年脑梗死患者预后的差别及影响因素[J].中国实用神经疾病杂志,2016,19(16): 20-22.
12
孙韬,靳力,宋玉中,等.中性粒细胞-淋巴细胞比值与急性脑梗死的相关性研究[J].贵州医科大学学报,2017,42(10): 1199-1202.
13
王莹莹,张健芳,蒋亚斌,等.中性粒细胞与淋巴细胞比值对急性脑梗死溶栓患者预后的预测[J].暨南大学学报(自然科学与医学版),2018,39(1): 35-40.
14
王晓蕊,黄彩云,苗昌荣,等.超敏C-反应蛋白、脂蛋白a及D-二聚体在脑梗死合并冠心病患者诊断中的价值[J].中国实用神经疾病杂志,2015,18(10): 76-77.
15
冯丽丽,张同存.超敏C反应蛋白、D-二聚体及脂蛋白(a)与急性脑梗死的相关性分析[J].中国卫生标准管理,2016,7(1): 154-155.
16
袁婷婷,王萌,赵昕,等.中性粒细胞和淋巴细胞比值和hs-CRP与急性脑梗死的相关性[J].中国神经免疫学和神经病学杂志,2016,23(3): 207-209.
17
姜红,黄文凤,陈玉珍,等.早期中性粒细胞与淋巴细胞比值脑梗死面积的预测价值[J].中华老年心脑血管病杂志,2015,17(8): 847-850.
18
高鹏举,李强.血浆B型脑钠肽前体和D-二聚体水平对急性脑梗塞预后的影响[J].湖南师范大学学报(医学版),2016,13(4): 118-120.
19
耿慧,孙伟,李素敏.急性脑梗死血浆D-二聚体NSE的动态分析[J].中国实用神经疾病杂志,2016,19(9): 64-66.
20
潘双杰,何远宏,王楠.首发缺血性卒中患者短期预后评价模型[J].实用医学杂志,2016,32(19): 3238-3241.
21
Imtiaz F, Shafique K, Mirza SS,et al. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population[J].Int Arch Med,2012,5(1): 2.
22
Wang RT, Zhang JR, Li Y,et al. Neutrophil-Lymphocyte ration is associated with arterial stiffness in diabetic retinopathy in type 2 diabetes[J].J Diabetes Complications,2015,29(2): 245-249.
23
Arbel Y, Finkelstein A, Halkin A,et al.Neutrophin/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography[J].Atherosclerosis,2012,225(2): 456-460.
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