Department of Neurology, Second Hospital of Lanzhou University, No. 82 Cuiyinmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.
J Neural Transm (Vienna). 2014 Apr;121(4):409-13. doi: 10.1007/s00702-013-1113-y. Epub 2013 Nov 8.
High-level plasma D-dimer suggests hypercoagulable states. There is a lack of correlation study of plasma D-dimer level and prognosis according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. The goal of this study is to explore the relationship between the plasma D-dimer level and the outcome of acute ischemic stroke patients among different stroke subtypes. We conducted a study of acute ischemic stroke patients admitted to the Department of Neurology in Second Hospital of Lanzhou University within 7 days of symptom onset. They were divided into different groups based on their subtypes according to TOAST criteria. In all the patients the plasma D-dimer levels were detected within 24 h of admission. Clinical neurological assessments were performed in line with National Institutes of Health Stroke Scale (NIHSS) once daily on the day of admission and on the 14th day. The outcome was evaluated by neurological improvement rate. Comparisons were made among the different subtypes based on the level of plasma D-dimer and the outcome. A total of 300 patients with acute ischemic stroke were included, 40 with cardioembolism; 47 with large-artery atherosclerosis; 143 with small-artery occlusion, 5 with other etiology stroke; and 65 with undetermined etiology stroke. The level of plasma D-dimer was negatively related to the outcome (r = -0.41; P = 0.013). Patients with cardioembolism had the highest level of plasma D-dimer and they suffered the most serious neurological deficit and the worst outcome among the five subtypes, the difference was statistically significant (F = 5.34; P = 0.012); while the lacunar stroke patients had the best outcome with the lowest level of D-dimer. High-level plasma D-dimer of acute period strongly indicates an unfavorable clinical outcome.
高水平的血浆 D-二聚体提示高凝状态。根据 Trial of Org 10172 in Acute Stroke Treatment（TOAST）分类，目前缺乏关于血浆 D-二聚体水平与预后相关性的研究。本研究旨在探讨不同卒中亚型的急性缺血性卒中患者的血浆 D-二聚体水平与结局的关系。
我们对在兰州大学第二医院神经内科住院且发病 7 天内的急性缺血性卒中患者进行了研究。根据 TOAST 标准，他们被分为不同的亚型组。所有患者均在入院后 24 小时内检测血浆 D-二聚体水平。入院当天及第 14 天，每天根据美国国立卫生研究院卒中量表（NIHSS）进行临床神经功能评估。通过神经功能改善率来评估结局。根据不同亚型的血浆 D-二聚体水平和结局进行比较。
共纳入 300 例急性缺血性卒中患者，其中 40 例为心源性栓塞；47 例为大动脉粥样硬化型；143 例为小动脉闭塞型；5 例为其他病因型；65 例为不明原因型。
血浆 D-二聚体水平与结局呈负相关（r=-0.41，P=0.013）。心源性栓塞患者的血浆 D-二聚体水平最高，神经功能缺损最严重，结局最差，五种亚型间差异有统计学意义（F=5.34，P=0.012）；而腔隙性卒中患者的 D-二聚体水平最低，结局最好。急性期高水平的血浆 D-二聚体强烈提示临床预后不良。
