血浆D-二聚体、C-反应蛋白和纤维蛋白原与脑出血预后的相关研究

目的揭示脑出血患者血浆D-二聚体（DD）、C-反应蛋白（CRP）和纤维蛋白原（Fg）浓度，分析其与脑出血预后的相关性，评价和比较其对脑出血死亡的预测价值。方法对40例健康体检者（对照组）和129例脑出血患者，用ELISA法检测血浆DD、CRP和Fq浓度，统计分析其水平改变及与预后的相关性。结果脑出血患者血浆DD、CRP和Fg浓度较对照组明显升高（P〈0．01），与GCS评分、血肿量、脑室积血及生存率有显著相关性（P〈O05）；ROC曲线辨别了判定界值，对预测脑出血后1个月内死亡均有较高的灵敏度和特异度（P〈0.05）；血浆DD曲线下面积显著大于CRP和Fg曲线下面积（P〈0．05）。结论DD、CRP和Fg共同参与了脑出血的病理生理过程，临床检测这些指标有助于早期判断脑出血预后，而血浆DD预测脑出血死亡有较高的临床价值。

Plasma D-dimer,C-reactive protein and fibrinogen levels in predicting the outcomes of acute intracerebral hemorrhage

Objective To evaluate the plasma levels of D-dimer, C-reactive protein and fibrinogen in predicting the disease outcomes of patients with spontaneous intracerebral hemorrhage （ICH）. Methods One hundred and twenty nine patients with acute ICH （ICH group） and 40 healthy controls （control group） were enrolled in the study. Plasma samples were collected within 24h after spontaneous onset of ICH. Concentrations of the plasma D-dimer, C-reactive protein, and fibrinogen were measured with ELISA. Results The plasma D-dimer, C-reactive protein and fibrinogen levels in the ICH group were significantly higher than those in the control group （all P〈0.01）, and were highly associated with GCS score, ICH volume, presence of intraventricular hemorrhage and survival rate in ICH （all P〈0.05）. A receiver operating characteristic curve （ROC） identified their cutoff levels that predicted 1-month mortality of patients with the high sensitivity and specificity values （all P〈0.05）. Areas under curve of plasma D-dimer levels were significantly larger than those of the plasma C-reactive protein and fibrinogen levels （P〈0.05）. Conclusion The plasma levels of D-dimer, C-reactive protein and fibrinogen are associated with clinical outcomes of patients with ICH, and can be served as clinical markers for evaluating the prognosis of the disease. Comparatively, detection of plasma D-dimer may be of more value.