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

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。

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

ObjectiveTo 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. MethodsA 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. ResultsThe 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]. ConclusionThere 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.