血清D-二聚体和超敏-C反应蛋白水平与脑梗死严重程度的相关性及脑梗死预后因素分析

摘要

Objective:To investigate the correlation between serum D-dimer and high sensitive C-reactive protein (hs-CRP) levels and severity of cerebral infarction,and to analyze the prognostic factors of cerebral infarction.Methods:235 patients with cerebral infarction in our hospital from March 2014 to October 2015 were selected and divided into mild,moderate and severe groups according to the severity of cerebral infarction.All patients received routine treatmentsuch as thrombolysis,antiplatelet,anticoagulation and neuroprotection.The severity of cerebral infarction was assessed by National Institute of Health Stroke Scale (NIHSS).The levels of D-dimer and hs-CRP in serum were determined by immunoturbidimetry.The correlation between serum D-dimer and hs-CRP levels and the severity of cerebral infarction were analyzed.All patients were followed up for 12 months after discharge,and the prognosis was evaluated by modified Rankin scale (MRS).The prognostic factors were analyzed by univariate analysis and multivariate logistic regression analysis.Results:The serum D-dimer and hs-CRP levels in the severe group were significantly higher than those in the moderate group and the mild group (P ＜0.01),and the moderate group was also higher than those in the mild group (P ＜0.01).Pearson analysis showed that the serum D-dimer and hsCRP levels were positively correlated with the severity of cerebral infarction (r =0.647,P ＜0.01;r =0.593,P ＜0.01).Multiple logistic regression analysis showed that age,hypertension,hyperlipidemia,infarct volume,NIHSS score as well as serum D-dimer and hs-CRP levels were independent risk factors for poor prognosis of cerebral infarction (P ＜0.01).Conclusion:The serum D-dimer and hs-CRP levels could predict the severity of cerebral infarction.Age,hypertension,hyperlipidemia,infarct volume,NIHSS score as well as serum D-dimer and hs-CRP levels were independent risk factors for poor prognosis of cerebral infarction.%目的:探讨血清D-二聚体(D-dimer)和超敏-C反应蛋白(hs-CRP)水平与脑梗死严重程度的相关性,并对脑梗死预后因素进行分析.方法:选取2014年3月至2015年10月在广东省陆丰市人民医院就诊的脑梗死患者235例为研究对象,均予以溶栓、抗血小板、抗凝和神经保护等常规治疗.采用免疫比浊法检测患者血清D-dimer和hs-CRP水平,采用美国国立卫生研究院卒中量表(NIHSS)评估梗死严重程度,Pearson相关分析分析血清D-dimer和hs-CRP水平与脑梗死严重程度的相关性.出院后随访12个月,用改良Rankin量表(MRS)评估预后情况,采用单因素和多因素Logistic回归分析法对脑梗死预后因素进行分析.结果:235例脑梗死患者中,轻度75例,中度97例,重度63例;预后良好169例,预后不良66例.重度患者血清D-dimer和hs-CRP水平高于中、轻度患者(P＜0.01),而中度患者又高于轻度患者(P＜0.01).血清D-dimer和hs-CRP水平与患者脑梗死严重程度呈正相关关系(r=0.647、r=0.593,P＜0.01).多因素Logistic回归分析结果显示,年龄、高血压、高血脂、梗死体积、NIHSS评分、D-dimer和hs-CRP水平是脑梗死预后不良的独立危险因素(P＜0.01).结论:临床上可通过检测患者血清D-dimer和hs-CRP水平来判断患者脑梗死的严重程度;年龄、高血压、高血脂、梗死体积、NIHSS评分、D-dimer和hs-CRP水平是脑梗死预后不良的独立危险因素.