摘要
目的:探讨血栓分子标志物对超早期脑梗死患者临床诊断价值。方法:选取2021年8月-2022年8月聊城市第三人民医院收治的100例超早期脑梗死患者作为病例组,收集患者临床资料,选择同期本院体检中心健康体检者100例为对照组。采用化学发光免疫分析法检测两组血浆中凝血酶-抗凝血酶复合物(Thrombin-antithrombin,TAT)、血栓调节蛋白(Thrombomodulin,TM)、纤溶酶-a2纤溶酶抑制物复合物(a2-plasmin inhibitor-plasmin complex,PIC)、组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(Tissue plasminogen activator-inhibitor complex,t-PAIC),免疫比浊法检测纤维蛋白原降解产物(Fibrin degradation products.FDP)及D-二聚体(D-dimer,DD)。采用受试者工作特征曲线(Receiveroperating characteristic,ROC)评价各项标志物的诊断价值。对综合评估符合静脉溶栓指征ACI患者进行溶栓治疗并于溶栓后24h、48h、72h检测血栓标志物水平及美国国立卫生研究院卒中量表(National institute ofhealth stroke scale,NIHSS)评分并分析评价溶栓效果。结果:病例组血浆TM,TAT、PIC,t-PAIC,FDP和DD水平均高于对照组,差异均有统计学意义(Z=6.176,-10.572,-10209-5.552,-9.181,-9.564,P均<001)。ROC曲线分析表明,TM,TAT,PIC,t-PAIC,FDP和DD单独诊断超早期脑梗死患者的AUC(95%CI)分别为0.753(0.687-0.819),0.933(0.895-0971),0918(0.875-0.960),0727(0.658-0796),0876(0.829-0922)和0890(0848-0933),联合诊断超早期脑梗死的AUC为0975(0939-0993)溶栓后24h血浆TAT,PIC,t-PAIC水平较溶栓前显著升高且NIHSS评分显著下降(X^(2)=27.761,42340,8.175 t=15.953,P均<005)。结论:超早期脑梗死患者血浆TM.TAT,PIC.t-PAIC水平明显升高,有助于判定其高凝状态及血栓形成,具有较好的临床诊断价值。溶栓患者动态监测血栓标志物水平,有助于评价溶栓治疗效果。
Objective:To explore the clinical diagnostic value of thrombus molecular markers in patients with ultra-early cerebral infarction.Methods:A total of 100 patients who received ultra-early cerebral infarction treatment in the Third People's Hospital of Liaocheng from August 2021 to August 2022 were selected as the case group.Among them,clinical data of patients were collected,and 100 patients who received health medical examinations in our hospital during the same period were selected as a control group.Chemoluminescent enzyme immunoassay was used to detect thrombin-antithrombin compexes(TAT),thromboregulatory protein(TM),plasminase-anti-fibrinoly-sis complexes(PIC)and tissue plasminogen activators/inhibitors-1 complexes(t-PAIC)in venous plasma.Immunoturbidimetry was used to detect fibrinogen degradation products(FDP)and D-dimer(DD).The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficiency of each marker.Thrombolytic therapy was performed in patients with ultra-early cerebral infarction who met the comprehensive evaluation of intravenous thrombolytic therapy,and the level of thrombus markers and NIHSS score were detected at 24 h,48 h,and 72 h after thrombolytic therapy,and the thrombolytic effect was analyzed and evaluated.Results:The levels of TAT,TM,PIC,t-PAIC,DD,and FDP were significantly higher in the case group than in the control group.The differences were statistically significant(Z=-6.176、-10.572、-10.209、-5.552、-9.181、-9.564,all P<0.01).The results showed that the AUC and confidence interval of plasma TM,TAT,PIC,t-PAIC,FDP,and DD were 0.753(0.687-0.819)、0.933(0.895-0.971)、0.918(0.875-0.960)、0.727(0.658-0.796)、0.890(0.848-0.933)and 0.876(0.829-0.922),respectively.The AUC of combined diagnosis was 0.975(0.939-0.993).After 24 hours of intravenous thrombolytic therapy,The levels of TAT,PIC,and t-PAIC were significantly higher and the NIHSS score was significantly lower in ultra-early cerebral infarction than before thrombolysis(χ^(2)=27.761、42.340、8.175,t=15.953,all P<0.05).Conclusions:The plasma levels of TM,TAT,PIC,and t-PAIC are significantly higher in ultra-early cerebral infarction patients,which is helpful to determine the hypercoagulable state and thrombosis and has good clinical diagnostic value.Dynamic monitoring of thrombus markers in thrombolytic patients is helpful to evaluate the efficacy of thrombolytic therapy.
作者
许光银
常立国
许红霞
钱海英
张斌
冯宁
赵顺锋
XU Guangyin;CHANG Liguo;XU Hongxia(Department of Clinical Laboratory,The Third People's Hospital of Liaocheng,Shandong Liaocheng 252000)
出处
《医学检验与临床》
2023年第4期6-11,共6页
Medical Laboratory Science and Clinics
基金
山东省医药卫生科技发展计划项目,项目编号:202011001446。
关键词
血栓
分子标志物
超早期脑梗死
诊断价值
Thrombus
Molecular marker
Ultra-early cerebral infarction
Diagnostic value
