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目的探讨急性颅脑损伤后血浆D-二聚体的动态变化对颅内进展性出血性损伤(PHI)及其预后的影响。方法前瞻性分析100例颅脑创伤患者(PHI组和非PHI组各50例)的临床资料,Logistic回归分析PHI发生的危险因素;受试者工作特征(ROC)曲线计算血浆D-二聚体浓度与PHI发生的关系。结果 PHI组的D-二聚体浓度分别为(5.57±6.05),(7.11±6.03),(4.90±4.54),(2.71±3.63),(1.56±3.11),对照组分别为(3.06±3.92),(1.90±3.26),(1.52±2.67),(0.93±1.68),(0.58±1.33),两组间同一时程差异有统计学意义(P<0.05)。Logistic多元回归分析显示,D-二聚体浓度与PHI的发生有关(OR=1.018,95%CI:0.894~1.158,P=0.034)。ROC曲线推算D-二聚体浓度的最佳临界值为1.245mg/L,此时灵敏度为96%,特异度为75%。结论颅脑损伤后血浆D-二聚体的水平可作为PHI发生的一个预判指标,结合影像学检查及其他相关临床因素分析可以更好地预判和及时诊断颅脑损伤后PHI的发生。
Objective To investigate the effect of dynamic changes of plasma D-dimer on intracranial progressive hemorrhagic injury (PHI) and its prognosis after acute craniocerebral injury. Methods The clinical data of 100 patients with traumatic brain injury (50 in each PHI group and non-PHI group) were prospectively analyzed. Logistic regression was used to analyze the risk factors of PHI. The receiver operating characteristic (ROC) curve was used to calculate plasma D-dimer Relationship between concentration and PHI. Results The D-dimer concentrations of PHI group were (5.57 ± 6.05), (7.11 ± 6.03), (4.90 ± 4.54), (2.71 ± 3.63) and (1.56 ± 3.11) ), (1.90 ± 3.26), (1.52 ± 2.67), (0.93 ± 1.68) and (0.58 ± 1.33) respectively. There was significant difference in the same time course between the two groups (P <0.05). Logistic multiple regression analysis showed that the concentration of D-dimer was related to the occurrence of PHI (OR = 1.018, 95% CI: 0.894-1.1558, P = 0.034). The best critical value of D-dimer concentration estimated by ROC curve is 1.245mg / L, the sensitivity is 96% and the specificity is 75%. Conclusion The level of plasma D-dimer after craniocerebral injury can be used as a predictor of PHI. Combined with imaging examination and other related clinical factors analysis, we can better predict and diagnose PHI after craniocerebral injury.