D-二聚体水平与伴有大血管闭塞的轻度缺血性卒中的预后
D-dimer level and outcome of minor ischemic stroke with large vessel occlusion.
作者信息
Sato Takeo, Sato Shoichiro, Yamagami Hiroshi, Komatsu Teppei, Mizoguchi Tadataka, Yoshimoto Takeshi, Takagi Masahito, Ihara Masafumi, Koga Masatoshi, Iwata Hiroyoshi, Matsushima Masato, Toyoda Kazunori, Iguchi Yasuyuki
机构信息
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
出版信息
J Neurol Sci. 2020 Jun 15;413:116814. doi: 10.1016/j.jns.2020.116814. Epub 2020 Mar 31.
OBJECTIVE
To determine the predictors of unfavorable outcomes in acute minor ischemic stroke patients with large vessel occlusion.
METHODS
The derivation cohort included ischemic stroke patients admitted to a comprehensive stroke center within 7 days after onset with large vessel occlusion and an initial National Institutes of Health Stroke Scale score of 5 or less. An unfavorable outcome was defined as dependency (modified Rankin Scale score of 3 to 6) at 3 months from the onset. The predictive values of factors related to an unfavorable outcome were evaluated. External validation was performed from a stroke registry of a tertiary medical center.
RESULTS
In the derivation cohort, 3839 consecutive patients were screened; a total of 130 patients were included. Twenty-four (18%) patients had unfavorable outcomes. In multivariate analysis, D-dimer ≥1900 μg/l (odds ratio (OR) 3.31, 95% confidence interval (CI) 1.14-9.61, p = .028) and age (OR 2.01, 95% CI 1.05-3.86, p = .035) were independently associated with an unfavorable outcome. No significant differences were observed regarding occluded vessel sites. In the validation cohort, 850 consecutive patients were screened; a total of 74 patients were included. D-dimer ≥1900 μg/l (OR 8.78, 95% CI 1.41-54.61, p = .020) was the only factor independently associated with an unfavorable outcome, as in the derivation cohort.
CONCLUSIONS
A high D-dimer level on admission could help predict unfavorable outcomes in patients with a minor ischemic stroke with large vessel occlusion.
目的
确定急性轻度缺血性卒中伴大血管闭塞患者不良预后的预测因素。
方法
推导队列包括发病7天内入住综合卒中中心、大血管闭塞且美国国立卫生研究院卒中量表初始评分≤5分的缺血性卒中患者。不良预后定义为发病3个月时依赖（改良Rankin量表评分3至6分）。评估与不良预后相关因素的预测价值。从一家三级医疗中心的卒中登记处进行外部验证。
结果
在推导队列中，共筛查了3839例连续患者；共纳入130例患者。24例（18%）患者预后不良。多因素分析显示，D-二聚体≥1900μg/l（比值比（OR）3.31，95%置信区间（CI）1.14 - 9.61，p = 0.028）和年龄（OR 2.01，95%CI 1.05 - 3.86，p = 0.035）与不良预后独立相关。闭塞血管部位未观察到显著差异。在验证队列中，共筛查了850例连续患者；共纳入74例患者。与推导队列一样，D-二聚体≥1900μg/l（OR 8.78，95%CI 1.41 - 54.61，p = 0.020）是与不良预后独立相关的唯一因素。
结论
入院时D-二聚体水平升高有助于预测轻度缺血性卒中伴大血管闭塞患者的不良预后。
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