中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (7): 592-597. doi: 10.3969/j.issn.1672-6731.2021.07.011

• 临床研究 • 上一篇    下一篇

2 急性缺血性卒中患者无症状深静脉血栓形成危险因素分析

李巍, 王莉莉, 李海燕, 付睿   

  1. 100038 首都医科大学附属北京世纪坛医院神经内科
  • 收稿日期:2021-02-02 出版日期:2021-07-25 发布日期:2021-07-26
  • 通讯作者: 付睿,Email:furui20080808@sina.com

Analysis of risk factors for asymptomatic deep venous thrombosis in patients with acute ischemic stroke

LI Wei, WANG Li-li, LI Hai-yan, FU Rui   

  1. Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2021-02-02 Online:2021-07-25 Published:2021-07-26

摘要:

目的 探讨急性缺血性卒中患者无症状深静脉血栓形成危险因素并确定风险指标的预测界值。方法 选择2018年9月至2019年6月经首都医科大学附属北京世纪坛医院确诊并符合纳入条件的239例急性缺血性卒中患者为观察对象,根据入院后7 d内多普勒超声结果筛查是否存在无症状深静脉血栓,通过单因素和多因素Logistic回归分析进行危险因素分析,采用受试者工作特征曲线(ROC曲线)确定风险指标预测界值。结果 共37例(15.48%)急性缺血性卒中患者发生无症状深静脉血栓,经Logistic回归分析显示,入院时高水平血浆D-二聚体(OR=1.012,95% CI:1.011~1.013;P=0.000)为其重要危险因素。血浆D-二聚体对急性缺血性卒中无症状深静脉血栓形成的诊断界值为343 ng/ml,其灵敏度为0.784、特异度0.901,ROC曲线下面积为0.89 ±0.03(95% CI:0.846~0.929,P=0.000)。结论 D-二聚体是急性缺血性卒中患者无症状深静脉血栓形成的重要标志物,其水平升高是无症状深静脉血栓形成的潜在危险因素。

关键词: 卒中, 脑缺血, 静脉血栓形成, 下肢, 危险因素, Logistic模型

Abstract:

Objective To explore the risk factors for asymptomatic deep venous thrombosis (DVT) in patients with acute ischemic stroke and determine the predictive value of risk indicators. Methods Two hundred thirty-nine acute ischemic stroke patients admitted to Beijing Shijitan Hospital, Capital Medical University from September 2018 to June 2019 met the inclusion criteria. According to the Doppler ultrasound results 7 d after admission, all eligible patients were screened for the presence of asymptomatic DVT. Univariate and multivariate Logistic regression analyses were used to identify risk factors for asymptomatic DVT. The value of risk factors for predicting asymptomatic DVT was analyzed by receiver operating characteristic curve (ROC) analysis. Results Thirty-seven (15.48%) patients with acute ischemic stroke had asymptomatic DVT. The multivariate forward Logistic regression analysis showed elevated D-dimer level on admission was the critical risk factor for asymptomatic DVT (OR=1.012, 95%CI:1.011-1.013; P=0.000). The cut-off value for plasma D-dimer in diagnosing asymptomatic DVT in the acute ischemic stroke patients was 343 ng/ml (sensitivity=0.784, specificity=0.901), and the area under the ROC curve was 0.89 ±0.03 (95%CI:0.846-0.929, P=0.000). Conclusions D-dimer is an essential marker of asymptomatic DVT in patients with acute ischemic stroke. Its elevated level is a potential risk factor for asymptomatic DVT.

Key words: Stroke, Brain ischemia, Venous thrombosis, Lower extremity, Risk factors, Logistic models