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目的研究急性缺血性脑卒中患者血浆蛋白原和D-二聚体水平的动态变化,探讨其在进展性卒中的作用和早期预测价值。方法筛选2012年1月至2012年12月在本院神经内科住院的急性缺血性卒中患者符合1995年全国第四届脑血管病学术会议修订的脑梗死诊断标准,将入组患者(发病24h内)进行NIHSS评分,小于22分者入组。对入组80名患者给予同样的治疗,一周进行神经功能评估,NIHSS评分增加2分以上的20例患者入急性进展性缺血性卒中组,其余60例患者入完全性缺血性卒中组。在两组患者发病24h、第3天、第7天、第14天,全自动血凝仪分别检测血浆纤维蛋白原和D-二聚体水平,同时对患者的神经功能缺损情况进行NIHSS评分。通过对血浆纤维蛋白原和D-二聚体的动态观察,探讨导致卒中进展的原因和机制,寻找可以预警卒中患者早期进展的预测因子。结果进展性卒中组发病24h内血浆纤维蛋白原和D-二聚体水平叫完全性卒中组升高更明显(P<0.01),第3天达最高峰,14天降至正常。完全性卒中组患者纤维蛋白原和D-二聚体水平在第3天有下降趋势,第7天时降至正常。结论监测缺血性脑卒中D-二聚体水平和血浆纤维蛋白原的各种变化,可以帮助早预测进展性卒中的发生,进展性卒中有更为明显的高凝状态。
Objective To study the dynamic changes of plasma protein and D-dimer levels in patients with acute ischemic stroke and to explore its role in early stroke and its predictive value. Methods Screening January 2012 to December 2012 in our hospital neurology hospitalized patients with acute ischemic stroke in line with the Fourth National Cerebrovascular Disease Conference in 1995 revised the diagnostic criteria for cerebral infarction, the inclusion group (onset 24h NIHSS score), less than 22 points into the group. Eighty patients were enrolled in the same treatment. Neurological evaluation was performed in one week. Twenty patients with an NIHSS score greater than 2 were included in the Acute Ischemic Stroke Group and the remaining 60 patients in the Complete Ischemic Stroke Group. In the two groups of patients onset 24h, 3 days, 7 days, 14 days, automatic coagulation analyzer were detected in plasma fibrinogen and D-dimer levels, while the patient’s neurological deficit NIHSS score. Through the dynamic observation of plasma fibrinogen and D-dimer, we explore the causes and mechanisms leading to stroke progression and find out the predictors that can predict the early progress of stroke patients. Results The level of plasma fibrinogen and D-dimer in progressive stroke group was significantly higher than that in the complete stroke group (P <0.01), reaching the peak on the third day and dropping to normal on the 14th day. In patients with complete stroke, fibrinogen and D-dimer levels decreased on the third day and returned to normal on the seventh day. Conclusions Monitoring changes in D-dimer levels and fibrinogen in ischemic stroke may help predict early onset of progressive stroke and more pronounced hypercoagulable state in progressive stroke.