2022 年第 8 期 第 17 卷

血清D-二聚体及中性粒细胞/淋巴细胞比值对老年非瓣膜性心房颤动患者合并急性心源性缺血性脑卒中的预测价值

The predictive value of serum D-dimer and neutrophil to lymphocyte ratio in elderly patients with non-valvular atrial fibrillation complicated with acute cardiogenic ischemic stroke 

作者：杨志鹏邓爱华王长远邢绣荣王晶李思颉孟然

英文作者：Yang Zhipeng Deng Aihua Wang Changyuan Xing Xiurong Wang Jing Li Sijie Meng Ran

单位：首都医科大学宣武医院急诊科，北京100053

英文单位：Department of Emergency Xuanwu Hospital Capital Medical University Beijing 100053 China

关键词：非瓣膜性心房颤动；急性心源性缺血性脑卒中；中性粒细胞/淋巴细胞比值；D-二聚体

英文关键词：Non-valvularatrialfibrillation;Acutecardiogenicischemicstroke;Neutrophiltolymphocyteratio;D-dimer

• 摘要：

• 目的 探讨血清D-二聚体及中性粒细胞/淋巴细胞比值（NLR）对老年非瓣膜性心房颤动（NVAF）患者合并急性心源性缺血性脑卒中的预测价值。方法 选取2016年1月至2019年12月首都医科大学宣武医院收治的289例老年NVAF患者的临床资料进行回顾性分析。将患者分为观察组（72例，NVAF合并急性心源性缺血性脑卒中患者）和对照组（217例，单纯NVAF患者）。记录2组一般资料和入院后第1次血常规、血清D-二聚体检测结果，并计算NLR。比较2组超声心动图指标。分析老年NVAF患者合并急性心源性缺血性脑卒中的危险因素，评估各指标的预测价值。结果 观察组糖尿病、高脂血症、吸烟史、饮酒史比例均高于对照组，差异均有统计学意义（均P＜0.05）。观察组白细胞计数、中性粒细胞计数、单核细胞计数、NLR、血清D-二聚体水平均高于对照组，淋巴细胞计数、每搏输出量、左心室射血分数均低于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，血清D-二聚体（比值比=2.382,95%置信区间：1.624～3.782）、NLR（比值比=1.268，95%置信区间：1.098～1.528）及每搏输出量（比值比=0.980，95%置信区间：0.957～0.993）为老年NVAF患者合并急性心源性缺血性脑卒中的独立危险因素（均P＜0.05）。受试者工作特征曲线分析结果显示，血清D-二聚体、NLR、每搏输出量及NLR联合D-二聚体预测老年NVAF患者合并急性心源性缺血性脑卒中的曲线下面积分别为0.784、0.766、0.621、0.822。结论 血清D-二聚体、NLR对判断老年NVAF患者发生急性心源性缺血性脑卒中具有一定的预测价值。

• Objective To investigate the predictive value of serum D-dimer and neutrophil to lymphocyte ratio (NLR) in elderly patients with non-valvular atrial fibrillation (NVAF) complicated with acute cardiogenic ischemic stroke. Methods Clinical data of 289 elderly patients with NVAF admitted to Xuanwu Hospital, Capital Medical University from January 2016 to December 2019 were retrospectively analyzed. They were divided into observation group (72 cases, patients with NVAF complicated with acute cardiogenic ischemic stroke) and control group (217 cases, patients with NVAF). The general data and the results of blood routine and serum D-dimer tests first day after admission were recorded, and the NLR was calculated. Indicators of echocardiography were compared between the two groups. Risk factors of elderly patients with NVAF complicated with acute cardiogenic ischemic stroke were analyzed, and their predictive value was evaluated. Results The proportions of diabetes mellitus, hyperlipidemia, smoking and drinking history in observation group were higher than those in control group (all P<0.05). The levels of leukocyte count, neutrophil count, monocyte count, NLR, serum D-dimer in observation group were higher than those in control group, and lymphocyte count, stroke output and left ventricular ejection fraction in observation group were lower than those in control group (all P<0.05). Multivariate Logistic regression analysis showed that serum D-dimer (odds ratio=2.382, 95% confidence interval: 1.624-3.782), NLR (odds ratio=1.268, 95% confidence interval: 1.098-1.528) and stroke output (odds ratio=0.980, 95% confidence interval: 0.957-0.993) were independent risk factors of elderly patients with NVAF complicated with acute cardiogenic ischemic stroke. Receiver operating characteristic curve analysis showed that the areas under the curve of serum D-dimer, NLR, stroke output and NLR+D-dimer were 0.784, 0.766, 0.621, and 0.822, respectively. Conclusion Serum D-dimer and NLR have certainly predictive value in acute cardiogenic ischemic stroke in elderly patients with NVAF.