CAJ | 학술논문

目的：探讨D-二聚体(DD)水平对脑梗死患者亚型的鉴别诊断价值。方法248例急性脑梗死患者根据TOAST分型将其分为大动脉粥样硬化组(89例)、小动脉粥样硬化组(88例)和心源性血栓组(71例)。对比三组患者的一般资料、DD水平，并于住院时和住院后10 d运用美国国立卫生研究院卒中量表（NIHSS）对患者神经功能的缺损状况进行评价。结果三组脑梗死患者之间的DD水平差异具有统计学意义(P<0.05)，心源性血栓组的DD水平最高，与大动脉粥样硬化组和小动脉粥样硬化组比较差异均具有统计学意义(P<0.05)；NIHSS评分结果显示，心源性血栓组的NIHSS评分显著高于大动脉粥样硬化组和小动脉粥样硬化组(P<0.05)，住院10 d后三组患者的NIHSS评分显著降低(P<0.05)，但三组之间的改善状况差异无统计学意义(P>0.05)。以DD水平预测心源性血栓模型，ROC曲线下面积为0.809(P=0.000)，95%CI为0.681~0.936，cutoff值为112 ng/ml，其特异度为0.586，敏感度为0.931。结论检测D-二聚体水平对于心源性血栓的检出具有重要的诊断价值。
목적：탐토D-이취체(DD)수평대뇌경사환자아형적감별진단개치。방법248례급성뇌경사환자근거TOAST분형장기분위대동맥죽양경화조(89례)、소동맥죽양경화조(88례)화심원성혈전조(71례)。대비삼조환자적일반자료、DD수평，병우주원시화주원후10 d운용미국국립위생연구원졸중량표（NIHSS）대환자신경공능적결손상황진행평개。결과삼조뇌경사환자지간적DD수평차이구유통계학의의(P<0.05)，심원성혈전조적DD수평최고，여대동맥죽양경화조화소동맥죽양경화조비교차이균구유통계학의의(P<0.05)；NIHSS평분결과현시，심원성혈전조적NIHSS평분현저고우대동맥죽양경화조화소동맥죽양경화조(P<0.05)，주원10 d후삼조환자적NIHSS평분현저강저(P<0.05)，단삼조지간적개선상황차이무통계학의의(P>0.05)。이DD수평예측심원성혈전모형，ROC곡선하면적위0.809(P=0.000)，95%CI위0.681~0.936，cutoff치위112 ng/ml，기특이도위0.586，민감도위0.931。결론검측D-이취체수평대우심원성혈전적검출구유중요적진단개치。
Objective To explore the differential diagnosis value of D-dimer (DD) level in patients with cere-bral infarction subtype. Methods A total of 248 patients with acute cerebral infarction were divided into large artery atherosclerosis group (89 cases), small artery atherosclerosis group (88 cases) and cardiac thrombus group (71 cases) according to the TOAST classification. The general information, DD level were compared between the three groups. The status of neurological function defect were evaluated by America using National Institutes of Health Stroke Scale (NIHSS) at admission and 10 days after admission. Results There were statistically significant differences in DD lev-el between the three groups (P<0.05). The DD level of cardiac thrombus group was the highest, compared with the large artery atherosclerosis group and small artery atherosclerosis group, and the differences were statistically signifi-cant (P<0.05). The NIHSS score in cardiac thrombus group was significantly higher than the large artery atherosclero-sis group and small atery atherosclerosis group (P<0.05). Ten days after admission, the NIHSS score of the three groups all decreased significantly (P<0.05), with no statistically significant differences between the three groups in the improvement (P>0.05). Predicting cardiac thrombosis model to the level of DD, the area under the ROC curve was 0.809 (P=0.000), with 95%CI of 0.681~0.936, cutoff value of 112 ng/ml, specificity of 0.586 and sensitivity of 0.931. Conclusion The detection of DD level has important diagnostic value for the detection of cardiac thrombosis.