血浆 D-二聚体对预判颅脑损伤后迟发性脑内血肿的应用价值

摘要

目的：探讨血浆 D-二聚体含量对预判创伤性颅脑损伤（TBI）后迟发性脑内血肿（DIH）的应用价值。方法选取新疆医科大学第五附属医院神经外科2013年9月－2015年9月收治的 TBI 患者71例，其中 TBI 后DIH 患者33例（研究组），非 DIH 患者38例（对照组）。采用免疫比浊法测定血浆中 D-二聚体含量，分析血浆 D-二聚体含量与 DIH 的关系。结果研究组 D-二聚体含量为（7．541±4．966）μg／mL，与对照组 D-二聚体含量（1．268±0．843）μg／mL 比较差异有统计学意义（P ＜0．05），两组入院时 GCS 评分、中线偏移＞0．5 cm、环池消失或者模糊、蛛网膜下腔出血、出院后3个月 GOS 评分比较差异有统计学意义（P ＜0．05）；单因素 Logistic 回归分析显示入院时 GCS 评分、D-二聚体含量、中线偏移＞0．5 cm、环池消失或者模糊、蛛网膜下腔出血均与 DIH 相关（P ＜0．05）。多因素 Logistic 回归分析显示 D-二聚体（P ＜0．05）与 DIH 相关性最强；ROC 曲线分析显示血浆 D-二聚体含量＞2．67μg／mL 时，曲线下面积＝0．989，95％ CI ＝0．971～1．000（P ＜0．001），灵敏度为100％，特异度为94．5％。结论TBI 患者血浆中 D-二聚体含量＞2．67μg／mL 时，对 DIH 的发生具有超早期预判价值。%Objective To investigate the value of the D-dimer in plasma for forecasting delayed intracerebral hematoma(DIH)after traumatic brain injury (TBI).Methods The 71 TBI patients were observed,and all of these patients were treated in the hospital of department of neurosurgery in the Fifth Affiliated Hospital of Xinjiang Medical University from September 2013 to September 2015,including 33 patients with DIH after TBI (study group)and 38 patients without DIH (control group).Immune turbidimetry method was used to measure the concentration of the D-dimer in plasma.Binary logistic regression,t test and ROC curve were used to analyze the relationship between D-dimer and DIH.Results The concentration of plas-ma D-dimer had statistical significance between study group [(7.541 ± 4.966)μg/mL]and the control group [(1.268±0.843)μg/mL (P <0.05)],and there were significantly different between the two groups in the GCS score on admission ,midline shift over 0.5 cm,ring pool disappear or blur,subarachnoid hem-orrhage and the GOS score after 3 months (P <0.05);univariate Logistic regression analysis showed that hospitalization GCS score,the D-dimer content ,midline shift over 0.5 cm,ring pool disappear or blur, subarachnoid hemorrhage were associated with DIH (P <0.05),multivariate Logistic regression analysis showed that D-dimer (P <0.05)was relevant to DIH;ROC curve analysis showed that when D-dimer lev-els were over 2.67 μg/mL,the area under the curve was 0.989,95% CI was 0.971-1.000 (P <0.001), sensitivity was 100%,specificity was 94.5%.Conclusion It is valuable when the D-dimer in plasma was more than 2.67 μg/mL to forecaste delayed intracerebral hematoma (DIH)after traumatic brain injury (TBI)in early.