动脉瘤性蛛网膜下腔出血血管内栓塞后D—dimer浓度变化与预后的关系

目的探讨动脉瘤性蛛网膜下腔出血（SAH）血管内栓塞后D-dimer浓度的变化以及D-dimer浓度升高能否做为预后不良的独立预测因素。方法对204例发病48h内人住我院和郑州大学第二附属医院神经内科的SAH病人，在手术当天早晨和动脉瘤填塞后14d检测血浆D-dimer浓度，3个月时根据格拉斯哥预后评分和CT随访脑梗塞的发生做为预后不良的预测因素。结果动脉瘤栓塞后预后不良的病人较预后良好者D—dimer浓度明显升高，手术当天2组各自平均为（1368±298）μg／L和（756土144）／xg／L，14d时分别为（1129±166）μg／I，和（356±73）μg／L，P〈O．001。重复检测发现，预后良好者D-climer浓度降低较快，排除其他影响因素后，D-dimer与预后不良有明显关系。结论SAH后血浆D-dimer升高是预后不良的独立预测因素，可能与凝血酶代谢产物过量积聚引起的损害有关。

Relationships between the concentrations of D-dimer and prognosis after intravascular embolization treatmentwith aneurismal subarachnoid hemorrhage

Objective To explore the changes of D-dimer levels in patients with subarachnoid hemorrhage（SAH） after in travascular embolization treatment, and whether elevated D-dimer levels is a predictor independently of poor outcome. Methods Two hundred and four patients with SAH were admitted in our hospital and the Second Affiliated Hospital of Zhengzhou U- niversity within 48 hours after bleeding, plasma Idimer was measured in the morning of aneurisma occlusion and at the 14 days after SAH. Factors predicting poor outcome were determined according to the Glasgow outcome scale （GOS）and CT follow-upappearance of cerebral infarction at 3 months after SAH. Results Patients with poor outcome had higher D-dimer levels than those with favorable outcome, and same-day surgery, a median（ 1368-4- 298）μg/L in the poor outcome patients and （ 756 ± 144） μg/L in the favorable outcome patients, respectively, and at 10 - 14 days were（ 1129 ±166）μg/L and（ 356± 73 ）μg/L, respec tively（P〉0. 001）. In repeated-measures, we found that I）-dimer levels decreased more rapidly in the avorable outcome pa- tients. After removed the other factors, plasma D-dimer after surgery remained a significant relation with poor outcome. Con- clusion Elevated plasma FYdimer after SAH is a predictor independently of poor outcome, suggesting that excess accumulated of thrombin generation may impair clinical outcome.