Department of Clinical Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei.
Blood Coagul Fibrinolysis. 2020 Jul;31(5):303-309. doi: 10.1097/MBC.0000000000000915.
: To evaluate analytic and clinical performance of plasma thrombin-antithrombin complex (TAT) and D-dimer assay in assessing the severity and outcome of acute ischemic stroke. The prospective study was conducted and extended from January 2018 to December 2018. A total of 236 patients admitted within 24 h after neurologic symptoms onset were recruited. The median TAT and D-dimer levels were significantly higher in the acute ischemic stroke patients than in the controls. The average TAT levels in patients with mild, moderately severe and severe stroke were 1.75 [interquartile ranges (IQR), 1.1-2.6], 3.3 (IQR, 1.8-4.5) and 13.5 (IQR, 7.2-15.3) ng/ml. The D-dimer levels of respective patient groups were 0.39 (IQR, 0.22-0.73), 0.58 (IQR, 0.39-1.25) and 3.59 (IQR, 1.73-4.74) mg/l. With the optimal cut-off TAT level (1.75 ng/ml) determined from receiver operating characteristic analysis, the Area under the curve (AUC), the sensitivity and specificity of TAT for stroke diagnosis were 0.763, 58.1 and 87.8%. The cut-off D-dimer level was 0.38 mg/l and the AUC, the sensitivity and specificity were 0.772, 60.2 and 88.9%. The Area under the receiver operating characteristic curves (AUROCs) and sensitivity in the moderate to severe stroke increased to 0.903 and 86.9% for TAT, and 0.880 and 80.3% for D-dimer, respectively. Age and high TAT level were significant independent risk factors for stroke severity. Age, high initial National Institutes of Health Stroke Scale score and high TAT level were significant independent poor prognostic factors on multivariate analysis. TAT and D-dimer were superior in separating the moderate-to-severe stroke than mild stroke. A high TAT plasma level is an independent predictor for stroke severity and poor prognosis during 1-month follow-up.
: 评估血浆凝血酶-抗凝血酶复合物（TAT）和 D-二聚体检测在评估急性缺血性脑卒中严重程度和预后中的分析和临床性能。本前瞻性研究于 2018 年 1 月至 12 月进行并扩展。共招募了 236 名发病后 24 小时内入院的患者。急性缺血性脑卒中患者的中位 TAT 和 D-二聚体水平明显高于对照组。轻度、中度和重度脑卒中患者的平均 TAT 水平分别为 1.75[四分位距（IQR），1.1-2.6]、3.3（IQR，1.8-4.5）和 13.5（IQR，7.2-15.3）ng/ml。相应患者组的 D-二聚体水平分别为 0.39（IQR，0.22-0.73）、0.58（IQR，0.39-1.25）和 3.59（IQR，1.73-4.74）mg/l。使用来自受试者工作特征分析的最佳截断 TAT 水平（1.75ng/ml），TAT 对脑卒中诊断的曲线下面积（AUC）、灵敏度和特异性分别为 0.763、58.1 和 87.8%。截断 D-二聚体水平为 0.38mg/l，AUC、灵敏度和特异性分别为 0.772、60.2 和 88.9%。TAT 的中度至重度脑卒中的受试者工作特征曲线下面积（AUROCs）和灵敏度分别增加至 0.903 和 86.9%，D-二聚体的 AUROCs 和灵敏度分别增加至 0.880 和 80.3%。年龄和高 TAT 水平是脑卒中严重程度的显著独立危险因素。年龄、较高的初始国立卫生研究院卒中量表评分和较高的 TAT 水平是多因素分析中显著的不良预后独立因素。TAT 和 D-二聚体在区分中重度脑卒中与轻度脑卒中方面更为优越。高 TAT 血浆水平是 1 个月随访期间脑卒中严重程度和不良预后的独立预测因子。
