血浆DFR对急性脑梗死患者静脉溶栓应答状态评估及临床治疗的指导作用OA
Plasma DFR in the assessment of intravenous thrombolysis response status and guiding role in clinical treatment of patients with acute cerebral infarction
目的 探讨血浆D-二聚体与纤维蛋白原比值(DFR)预测急性脑梗死患者静脉溶栓应答情况的价值.方法 研究对象为2023-10-2025-06于首都医科大学附属北京世纪坛医院接受静脉溶栓治疗的125例急性脑梗死患者,采用全自动凝血分析仪测定血浆D-二聚体和纤维蛋白原水平,计算DFR.治疗前后采用NIHSS评分评估患者情况,分为应答良好组(88例)和应答不良组(37例).结果 经静脉溶栓治疗后,88例(70.40%)应答良好,37例(29.60%)应答不良.应答不良组患者糖尿病比例显著高于应答良好组,治疗前NIHSS评分显著升高,差异有统计学意义(P<0.05).应答良好组患者治疗前DFR为0.47±0.07,显著低于应答不良组患者的0.59±0.09,差异有统计学意义(t=-5.762,P<0.001).治疗前DFR与治疗前NIHSS评分无显著相关性(r=0.062,P=0.494),与治疗后NIHSS评分存在显著正相关关系(r=0.215,P=0.016).多因素Logistic回归分析表明,糖尿病和较高的血浆DFR是患者治疗后应答不良的独立危险因素(P<0.05).治疗前DFR预测急性脑梗死患者静脉溶栓应答不良的ROC曲线AUC为0.916(0.861～0.970)(P<0.001),敏感度86.5%,特异度85.2%,截断值0.53.结论 治疗前较高的血浆DFR与急性脑梗死患者静脉溶栓治疗后应答不良有关,且具有较好的预测价值,对选择合适的治疗方式具有指导意义.
Objective To investigate the value of plasma D-dimer to fibrinogen ratio(DFR)in predicting the response to intravenous thrombolysis in patients with acute cerebral infarction.Methods The study included 125 patients with acute cerebral infarction who were treated by intravenous thrombolysis in Beijing Shijitan Hospital,Capital Medical University between October 2023 and June 2025.The levels of plasma D-dimer and fibrinogen were determined by an automatic coagulation analyzer,and the DFR was calculated.The NIHSS score was used to assess the patients before and after treatment,and they were split into two groups:the good response group(88 cases)and the poor response group(37 instances).Results After intravenous thrombolysis therapy,among the 125 patients with acute cerebral infarction,88 had good response and 37 had poor response.Compared with the good response group,the poor response group had significantly higher proportion of patients with diabetes and significantly higher NIHSS score before treatment,with statistically significant differences(P<0.05).The DFR before treatment of patients in the good response group was 0.47±0.07,which was significantly lower than that of the poor response group(0.59±0.09),and the difference was statistically significant(t=-5.762,P<0.001).There was no significant correlation between DFR before treatment and NIHSS score before treatment(r=0.215,P=0.016).Higher plasma DFR was an independent risk factor for patients'poor post-treatment response according to multivariate Logistic regression analysis(P<0.05).The AUC of DFR for predicting poor intravenous thrombolysis response in patients with acute cerebral infarction before treatment was 0.916(0.861-0.970)(P<0.001),with the sensitivity of 86.5%,the specificity of 85.2%,and the cutoff value of 0.53.Conclusion Higher plasma DFR before treatment is associated with poor response after intravenous thrombolytic therapy in patients with acute cerebral infarction,and it has a good predictive value,which is of guiding significance for the selection of appropriate treatment methods.
吕颖;王海燕;殷宇慧;熊璐璐
首都医科大学附属北京世纪坛医院,北京 100038首都医科大学附属北京世纪坛医院,北京 100038首都医科大学附属北京世纪坛医院,北京 100038首都医科大学附属北京世纪坛医院,北京 100038
医药卫生
急性脑梗死D-二聚体与纤维蛋白原比值静脉溶栓应答不良预测价值血浆
Acute cerebral infarctionD-dimer to fibrinogen ratioIntravenous thrombolysisPoor responsePredictive valuePlasma
《中国实用神经疾病杂志》 2026 (6)
674-678,5
国铁集团2023年医疗卫生专项科研项目计划(编号:J2023Z611)
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