D-二聚体最佳切点与急性缺血性脑卒中病人危险因素关系及预后价值评估

目的探讨D-二聚体（D-D）最佳切点值与急性缺血性脑卒中（acute ischemic stroke，AIS）病人危险因素关系，并对其预后价值评估。方法选择48例AIS病人作为观察组，同时选择35名健康体检者为对照组，检测其D-D、同型半胱氨酸（Hcy）、脂蛋白ALp（a）]、总胆固醇（TC）、三酰甘油（TG）、超敏C反应蛋白（hs-CRP）；采用SPSS 21.0软件分析获得其受试者工作特征（ROC）曲线和预测AIS危险因素切点值；此外对AIS采用非条件logistic回归模型进行分析。结果AIS组病人与健康对照组D-D、Hcy、Lp（a）、hs-CRP和TG水平差异具有统计学意义（P < 0.05~P < 0.01）。D-D的曲线下面积最高，为0.966；AIS病人危险因素切点临界值为1.04 mg/L，诊断灵敏度和特异性，分别为87.5%和97.1%。多元logistic回归分析显示D-D、Lp（a）、Hcy是AIS病人的独立危险因素，其相对危险系数分别为15.000、13.800、11.825。D-D水平与高血压、TG无相关性（P>0.05），与Hcy、Lp（a）和hs-CRP呈正相关性（P < 0.05）。随着D-D水平的增高，AIS预后不良病人的比率增高。结论在预测AIS病人危险因素时，D-D是较好的预测指标，最佳预测界值是1.04 mg/L，D-D水平升高是AIS的独立危险因素之一，可增加其发病风险。

Relationship between the optimal cut point of D-dimer and risk factors in patients with acute ischemic stroke,and its value in evaluating prognosis

ObjectiveTo explore the relationship between the optimal cut point of D-dimer(D-D) and risk factors in patients with acute ischemic stroke(AIS), and its value in evaluating prognosis.MethodsA total of 48 AIS patients and 35 healthy people were divided into the observation group and control group, respectively.The levels of D-D, homocysteine(Hcy), lipoprotein ALp(a)], total cholesterol(TC), triglycerol(TG) and hypersensitive C reactive protein(hs-CRP) were detected in two groups.SPSS software 21.0 was used to analyze the receiver operating characteristic(ROC) curve, and predict the risk factors of AIS.The AIS was analyzed using non-conditional logistic regression model.ResultsThe differences of the levels of D-D, Hcy, Lp(a), hs-CRP and TG between two groups were statistically significant(P < 0.05~P < 0.01).The area under the ROC curve of D-D was the highest, which was 0.966.The critical cut-off value of risk factors in AIS patients was 1.04 mg/L, and the diagnostic sensitivity and specificity were 87.5% and 97.1%, respectively.Multiple logistic regression analysis showed that D-D, Lp(a) and Hcy were the independent risk factors of AIS patients, and their relative risk coefficients were 15.000, 13.800 and 11.825, respectively.There was not correlation between D-D level and hypertension, TG(P>0.05), and the D-D level was positively correlated with the levels of Hcy, Lp(a) and hs-CRP(P < 0.05).With the increasing of D-D level, the proportion of AIS patients with poor prognosis increased.ConclusionsD-D is a better predictor in the prediction of risk factors of AIS patients, the optimal predicted threshold is 1.04 mg/L.The increasing of D-D level is one of the independent risk factors of AIS, which can increase the risk of AIS.