Wang Yanling, Hafeez Adam, Meng Fanhua, Zhang Ruihua, Wang Xuemei, Chen Xiaomeng, Kong Qi, Du Huishan, Ma Xin
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.
Neurol Res. 2016 Jun;38(6):524-32. doi: 10.1080/01616412.2016.1187829.
To investigate the correlation between nerve function defect, their degree of recovery, and D-dimer levels in patients with acute ischemic cerebrovascular disease (AICVD) complicating coronary heart disease (CHD) in winter.
From 1 October, 2014 to 31 December, 2014, we enrolled patients in a consecutive manner with AICVD who were hospitalized in the Department of Neurology, Beijing Luhe hospital, Capital Medical University. The patients were selected that had an occurrence of AICVD within the last 14 days. A total of 151 cases were divided into CHD group (n = 77) or non-CHD group (n = 74) based on a diagnosis of CHD. The risk factors, hematological indices associated with the diseases, and the nerve function defect and recovery degrees were compared between the two groups. Moreover, according to the result of the preliminary analysis of the CHD and non-CHD groups, patients were further divided into two subgroups based on whether their D-dimer levels were higher than 0.5 mg/l or not. Finally, the nerve function defect and recovery degrees in each subgroups were compared in pairs.
Among the patients consecutively enrolled, the percentage of the patients with CHD was 50.99% (77/151) and non-CHD patients was 49.01%. On admission, there was no significant difference in NIHSS scores between the CHD and non-CHD groups. However, there was a significant difference between the CHD and non-CHD groups when comparing the NIHSS scores on 14th day and the mRs scores on 90 (±7)th day after the initial onset (p = 0.006, 0.005). The D-dimer levels of AICVD complicating CHD patients were higher than those not complicating CHD patients (p = 0.006). Those AICVD patients that complicating CHD with also elevated D-dimer levels had most severe neurologic function deficits on 14th day and worst neural function recoveries on 90 (±7)th day after onset (p = 0.001, <0.001).
AICVD patients complicating CHD is very common in clinical practice. The AICVD patients that complicating CHD showed worse outcomes within 90 days after initial onset of stroke. The D-dimer levels of patients with AICVD complicating CHD were higher. Patients in the CHD group, whose D-dimer levels were higher than the normal standard, had worst outcomes. Paying close attention to the stage of the coronary artery disease and indicators of the coagulation-fibrinolysis is beneficial in the optimization of the clinical treatment for AICVD patients. Maybe the results of this study could provide some reference for specific groups of stroke patients to accept anticoagulant therapy.
探讨冬季急性缺血性脑血管病（AICVD）合并冠心病（CHD）患者神经功能缺损、恢复程度与D - 二聚体水平之间的相关性。
2014年10月1日至2014年12月31日，我们连续纳入首都医科大学附属北京潞河医院神经内科住院的AICVD患者。入选患者为在过去14天内发生AICVD者。根据CHD诊断将151例患者分为CHD组（n = 77）和非CHD组（n = 74）。比较两组的危险因素、与疾病相关的血液学指标以及神经功能缺损和恢复程度。此外，根据CHD组和非CHD组的初步分析结果，将患者进一步分为D - 二聚体水平是否高于0.5mg/l的两个亚组。最后，成对比较各亚组的神经功能缺损和恢复程度。
在连续入选的患者中，CHD患者占50.99%（77/151），非CHD患者占49.01%。入院时，CHD组和非CHD组的美国国立卫生研究院卒中量表（NIHSS）评分无显著差异。然而，在比较发病后第14天的NIHSS评分和第90（±7）天的改良Rankin量表（mRs）评分时，CHD组和非CHD组之间存在显著差异（p = 0.006，0.005）。AICVD合并CHD患者的D - 二聚体水平高于未合并CHD的患者（p = 0.006）。那些AICVD合并CHD且D - 二聚体水平也升高的患者在发病后第14天神经功能缺损最严重，在第90（±7）天神经功能恢复最差（p = 0.001，<0.001）。
AICVD合并CHD患者在临床实践中非常常见。AICVD合并CHD的患者在卒中初发后90天内预后较差。AICVD合并CHD患者的D - 二聚体水平较高。CHD组中D - 二聚体水平高于正常标准的患者预后最差。密切关注冠状动脉疾病阶段和凝血 - 纤溶指标有利于优化AICVD患者的临床治疗。也许本研究结果可为特定组别的卒中患者接受抗凝治疗提供一些参考。
