High Plasma D-Dimer is a Marker of Deep Vein Thrombosis in Acute Stroke
High Plasma D-Dimer is a Marker of Deep Vein Thrombosis in Acute Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2010.06.009
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发表时间：
2012-04-01
影响因子：
2.5
通讯作者：
Minematsu, Kazuo
中科院分区：
文献类型：
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作者：
Kuwashiro, Takahiro;Toyoda, Kazunori;Minematsu, Kazuo
本研究探讨血浆D-二聚体水平是否有助于检测急性卒中患者的深静脉血栓形成(DVT)。对133例卒中后3天内入院的患者进行了双功能静脉超声检查和重复测定血浆D-二聚体水平。在100例缺血性卒中患者中36例和33例脑出血(ICH)患者中25例检测到DVT(76%；P<0.01)。DVT患者入院时血浆D-二聚体水平(7.5+/-10.7mU/mLvs 3.7+/-10.1mU/m L；P=0.040)和超声检查前最大值(29.1+/-48.7mU/mLvs5.5+/-11.0mU/m L；P<；.001)均高于非DVT患者。多因素Logistic回归分析显示，最大D-二聚体水平与DVT的诊断独立相关(优势比[OR]1.05；95%可信区间[CI]，每增加1微克/毫升1.00~1.09；P=0.045)，但入院时D-二聚体水平与DVT无关。此外，女性(OR，4.99)、脑出血(OR，5.20)、Wells临床评分高(OR，每增加1分2.40)、低蛋白水平(OR，每1-g/dL增加0.21)是DVT的独立相关因素。DVT阳性的D-二聚体最大值的最佳界值为5.5mUg/mL(敏感性为89%，特异性为82%)。提示急性卒中病程中血浆D-二聚体水平升高有助于双功能静脉超声检测DVT。
This study investigated whether plasma D-dimer level is useful for detection of deep vein thrombosis (DVT) in patients with acute stroke. A total of 133 patients hospitalized within 3 days after stroke onset underwent duplex venous ultrasonographic examination of the lower limbs and repeated measurements of plasma D-dimer level. DVT was detected in 36 of 100 patients with ischemic stroke and in 25 of 33 patients with intracerebral hemorrhage (ICH) (76%; P < .001). Plasma D-dimer level on admission (7.5 +/- 10.7 mu g/mL vs 3.7 +/- 10.1 mu g/mL; P = .040) and its maximum level before the ultrasonographic examination (29.1 +/- 48.7 mu g/mL vs 5.5 +/- 11.0 mu g/mL; P < .001) were higher in the patients with DVT compared with those without DVT. On multivariate logistic regression analysis, the maximum D-dimer level was independently related to the identification of DVT (odds ratio [OR] 1.05; 95% confidence interval [CI], 1.00-1.09 per 1 mu g/mL increase; P = .045), but the admission D-dimer level was not when it was included instead of the maximum D-dimer level. In addition, female sex (OR, 4.99), ICH (OR, 5.20), high Wells clinical score (OR, 2.40 per 1-point increase), and low protein level (OR, 0.21 per 1-g/dL increase) were independently related to the identification of DVT. The optimum cutoff value of the maximum D-dimer level for positive DVT was 5.5 mu g/mL (sensitivity, 89%; specificity, 82%). Our findings suggest that high plasma D-dimer level during the course of acute stroke can help detect DVT on duplex venous ultrasonography.