Objective To study the diagnostic value of combined examination of homocysteine ,C reactive pro‐tein and D‐dimer in patients with acute cerebral infarction .Methods From January 2011 to October 2014 ,82 patients with ACI were chosen as study objective ,and all patients were divided into 3 groups according to the infarction size :13 in L group ,47 in M group and 22 in S group .At the same time ,100 healthy people were chosen as control group . The serum level of Hcy ,CRP and D‐dimer were compared among different group ,and the diagnostic value of Hcy , CRP ,D‐dimer and combined examination were studied .Results The serum level of Hcy ,CRP and D‐dimer had sig‐nificant difference among different groups(P< 0 .05) .The sensitivity of Hcy was 84 .14% ,specificity was 96 .00% , Youden index was 0 .801 4 ,negative predictive value was 88 .07% ;The sensitivity of CRP was 90 .24% ,specificity was 91 .00% ,Youden index was 0 .812 4 ,negative predictive value was 91 .92% ;The sensitivity of D‐dimer was 75 .61% ,specificity was 98 .00% ,Youden index was 0 .736 1 ,negative predictive value was 83 .05% ;The sensitivity of Hcy + CRP + D‐dimer was 98 .78% ,specificity was 89 .00% ,Youden index was 0 .877 8 ,negative predictive value was 98 .89% ,and the difference had statistical significance(P< 0 .05) .The positive predictive value had no statistical difference among different methods (P > 0 .05) .Conclusion The combined examination of hmocysteine ,C reactive protein and D‐dimer can be used in the investigation of acute cerebral infarction ,which has diagnostic value .%目的：探讨血清同型半胱氨酸（Hcy）、C反应蛋白（CRP）、D‐二聚体（D‐D）联合检测对急性脑梗死（ACI）患者的临床价值。方法选取2012年1月至2014年10月该院收治的82例 ACI 患者作为观察对象，根据梗死体积分为3组：大梗死组（L 组）13例，中梗死组（M 组）47例，小梗死组（S 组）22例；选取同一时期的100例健康者作为健康对照组，比较各组 Hcy 、CRP 、D‐D 水平和 Hcy 、CRP 、D‐D 三者联合检测对 ACI 的诊断价值。结果各组研究对象 Hcy 、CRP 、D‐D 水平比较，差异有统计学意义（P ＜0．05）。 Hcy 灵敏度为84．14％，特异度96．00％，正确诊断指数0．8014，阴性预测值88．07％；CRP 灵敏度90．24％，特异度91．00％，正确诊断指数0．8124，阴性预测值91．92％；D‐D 灵敏度75．61％，特异度98．00％，正确诊断指数0．7361，阴性预测值83．05％；Hcy ＋ CRP ＋ D‐D灵敏度98．78％，特异度89．00％，正确诊断指数0．8778，阴性预测值98．89％，差异有统计学意义（P ＜0．05）。Hcy 、CRP 、D‐D 三者联合的阳性预测值差异无统计学意义（P＞0．05）。结论 Hcy 、CRP 、D‐D 联合检测可用于 ACI预测，具有一定的临床诊断价值。
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