Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction

LIU Yan; XU Xuhui; GONG Jing; CHEN Shuo

doi:10.14188/j.1671-8852.2023.0388

您当前的位置：

首页 >

文章列表页 >

Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction

更新时间：2026-11-05

- Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction
- Medical Journal of Wuhan University Vol. 46, Issue 6, Pages: 749-753(2025)
- 作者机构：
  
  东南大学医学院附属南京同仁医院神经内科江苏南京 211100
- 作者简介：
- 基金信息：
- DOI：10.14188/j.1671-8852.2023.0388
  CLC： R743.33
- Received：12 July 2023，
  
  Published：25 June 2025
- 稿件说明：
移动端阅览
刘艳,徐旭慧,龚静等.急性脑梗死溶栓后预后影响因素及血清D‑二聚体、胆红素、尿素氮预测价值[J].武汉大学学报（医学版）,2025,46(06):749-753.

LIU Yan,XU Xuhui,GONG Jing,et al.Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction[J].Medical Journal of Wuhan University,2025,46(06):749-753.
刘艳,徐旭慧,龚静等.急性脑梗死溶栓后预后影响因素及血清D‑二聚体、胆红素、尿素氮预测价值[J].武汉大学学报（医学版）,2025,46(06):749-753. DOI： 10.14188/j.1671-8852.2023.0388.

LIU Yan,XU Xuhui,GONG Jing,et al.Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction[J].Medical Journal of Wuhan University,2025,46(06):749-753. DOI： 10.14188/j.1671-8852.2023.0388.

摘要

目的

探讨急性脑梗死（ACI）溶栓后预后影响因素及血清D‑二聚体（D‑D）、胆红素（TB）、尿素氮（BUN）的预测价值。

方法

选择东南大学医学院附属南京同仁医院2021年5月到2023年5月所接诊的117例ACI溶栓患者作为研究对象，在治疗3个月后采用改良Rankin量表（mRS）评分对患者的预后进行评估，分为预后不良组（

＝40）、预后良好组（

=77）。比较两组临床资料、不同预后患者的血清D‑D、TB、BUN的表达情况，采用Logistic回归分析影响ACI患者溶栓后预后的危险因素，并采用受试者工作特征曲线（ROC）评价血清D‑D、TB、BUN指标对ACI溶栓后预后的预测价值。

结果

两组性别、吸烟、饮酒、高血压史、糖尿病史、脑卒中史、血压比较，差异无统计学意义（

0.05）；两组年龄、血脂、血糖、发病至溶栓时间、入院时NIHSS评分比较，差异均有统计学意义（

0.05）；预后不良组患者的血清D‑D、BUN均明显高于预后良好组，TB水平明显低于预后良好组（

0.05）；经Logistic回归分析显示，血清D‑D、TB、BUN均是影响ACI患者溶栓后预后的影响因素（

0.05）；采用ROC曲线分析结果显示，血清D‑D、TB、BUN的ROC曲线下面积分别为0.964、0.868、0.921，诊断敏感度分别为87.50%、90.00%、87.50%，特异度分别为98.70%、71.40%、87.00%，截断值分别为2.835 mg·L

-1

、18.605 μmol·L

-1

、11.645 mmol·L

-1

，三者中D‑D曲线下面积最大且诊断特异度最高，TB诊断敏感度最高（

0.05）。

结论

年龄、血脂、血糖、发病至溶栓时间、入院时NIHSS评分、血清D‑D、TB、BUN均为ACI患者溶栓后预后的独立危险因素，血清D‑D、TB、BUN对ACI患者溶栓后预后具有较高的预测价值。

Abstract

Objective

To investigate the prognostic factors and the predictive value of serum D‑dimer (D‑D)

bilirubin (TB) and urea nitrogen (BUN) after thrombolysis in acute cerebral infarction (ACI).

Methods

A total of 117 patients with ACI thrombolytic therapy in our hospital from May 2021 to May 2023 were selected as the study objects

after 3 months of treatment

the improved Rankin Scale (mRS) score was used to evaluate the prognosis of the patients

including the poor prognosis group (

=40) and the good prognosis group (

=77). The expression levels of serum D‑D

TB and BUN in patients with different prognosis were compared between the two groups. Logistic regression was used to analyze the risk factors affecting the prognosis of ACI patients after thrombolysis

and receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum D‑D

TB and BUN indexes on the prognosis of ACI patients after thrombolysis.

Results

There was no significant difference in gender

smoking

drinking

history of hypertension

diabetes

stroke and blood pressure between the two groups (

0.05). There were significant differences in age

blood lipid

blood glucose

time from onset to thrombolysis and NIHSS score at admission between the two groups (

0.05); the serum D‑D and BUN levels in the poor prognosis group were significantly higher than those in the good prognosis group

and the TB levels were significantly lower than those in the good prognosis group (

0.05); Logistic regression analysis showed that serum D‑D

TB and BUN were all influencing factors for the prognosis of ACI patients after thrombolysis (

0.05); ROC curve analysis showed that the area under ROC curve of serum D‑D

TB and BUN were 0.964

0.868 and 0.921

respectively. The diagnostic sensitivity was 87.50%

90.00% and 87.50%

and the specificity was 98.70%

71.40% and 87.00%

the cutoff values were 2.835 mg·L

-1

18.605 μmol·L

-1

and 11.645 mmol·L

-1

respectively. The area under D‑D curve was the largest

the diagnostic specificity was the highest

and the diagnostic sensitivity of TB was the highest (

0.05).

Conclusion

Age

blood lipid

blood glucose

time from onset to thrombolysis

NIHSS score at admission

serum D‑D

TB and BUN were all independent risk factors for prognosis after thrombolytic therapy in ACI patients. Serum D‑D

TB and BUN had high predictive value for prognosis after thrombolytic therapy in ACI patients.

关键词

Keywords

references

段延龙 , 张春阳 , 石秋艳 , 等 . 急性脑梗死静脉溶栓患者出血转化及预后的危险因素研究 [J ] . 中风与神经疾病杂志 , 2021 , 38 ( 1 ): 36 ‑ 41 .

DUAN Y L , ZHANG C Y , SHI Q Y , et al . Risk factors of hemorrhagic transformation and prognosis in patients with acute cerebral infarction and intravenous thrombolysis [J ] . J Apoplexy Nerv Dis , 2021 , 38 ( 1 ): 36 ‑ 41 .

LEE S H , JUNG J M , KIM K Y , et al . Intramural hematoma shape and acute cerebral infarction in intracranial artery dissection: A high‑resolution magnetic resonance imaging study [J ] . Cerebrovasc Dis , 2020 , 49 ( 3 ): 269 ‑ 276 .

邹辉 , 杜鑫 . 血清D‑二聚体和间接胆红素水平在预测缺血性脑卒中溶栓后脑出血转化的临床价值 [J ] . 实用医院临床杂志 , 2022 , 19 ( 6 ): 130 ‑ 133 .

ZOU H , DU X . The clinical value of levels of serum D‑dimer and indirect bilirubin in predicting cerebral hemorrhage transformation after thrombolysis in ischemic stroke [J ] . Pract J Clin Med , 2022 , 19 ( 6 ): 130 ‑ 133 .

CHEN T , LI A P , GONG Q , et al . The association of blood urea nitrogen to creatinine ratio and the prognosis of critically ill patients with cerebral infarction: A cohort study [J ] . Mediators Inflamm , 2022 , 2022 : 2151840 .

中华医学会神经病学分会 , 中华医学会神经病学分会脑血管病学组 . 中国急性缺血性脑卒中诊治指南2018 [J ] . 中华神经科杂志 , 2018 , 51 ( 9 ): 666 ‑ 682 .

Chinese Society of Neurology , Cerebrovascular Group , Chinese Society of Neurology . Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018 [J ] . Chin J Neurol , 2018 , 51 ( 9 ): 666 ‑ 682 .

OGAWA Y , INAGAWA M , KIMURA M , et al . Nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing is associated with a shorter hospital stay for patients with acute cerebral infarction: A retrospective study [J ] . Asia Pac J Clin Nutr , 2021 , 30 ( 2 ): 199 ‑ 205 .

梁菊萍 , 杨旸 , 董继存 . 急性脑梗死患者流行病学调查及危险因素 [J ] . 中国老年学杂志 , 2021 , 41 ( 12 ): 2484 ‑ 2487 .

LIANG J P , YANG Y , DONG J C . Epidemiological investigation and risk factors of patients with acute cerebral infarction [J ] . Chin J Gerontol , 2021 , 41 ( 12 ): 2484 ‑ 2487 .

韦菊临 , 赵志雄 . 青年与中老年急性脑梗死MR特点和危险因素对比研究 [J ] . 影像科学与光化学 , 2020 , 38 ( 4 ): 684 ‑ 689 .

WEI J L , ZHAO Z X . Comparative study on MR characteristics and risk factors between young patients and middle‑aged and elderly patients with acute ischemic stroke and the value of prevention [J ] . Imag Sci Photochem , 2020 , 38 ( 4 ): 684 ‑ 689 .

陈佳露 , 张继 . 急性脑梗死影像因素评估近期预后的研究 [J ] . 实用放射学杂志 , 2021 , 37 ( 2 ): 188 ‑ 190 .

CHEN J L , ZHANG J . Study on imaging factors in evaluating short‑term prognosis of acute cerebral infarction [J ] . J Pract Radiol , 2021 , 37 ( 2 ): 188 ‑ 190 .

康凌 . 急性脑梗死静脉溶栓近期预后的影响因素分析 [J ] . 中西医结合心脑血管病杂志 , 2021 , 19 ( 24 ): 4387 ‑ 4390 .

KANG L . Analysis of influencing factors on short‑term prognosis of intravenous thrombolysis in acute cerebral infarction [J ] . Chin J Integr Med Cardio Cerebrovasc Dis , 2021 , 19 ( 24 ): 4387 ‑ 4390 .

马慧 , 杜和宝 , 苏增锋 , 等 . 急性脑梗死患者血浆D‑二聚体水平对病情及预后的影响 [J ] . 神经损伤与功能重建 , 2022 , 17 ( 9 ): 547 ‑ 549 .

MA H , DU H B , SU Z F , et al . Effect of plasma D‑dimer level on the condition and prognosis of patients with acute cerebral infarction [J ] . Neural Inj Funct Reconstr , 2022 , 17 ( 9 ): 547 ‑ 549 .

李景莉 , 孙丽燕 , 来治国 , 等 . 血清总胆红素和iNOS联合检测对rt‑PA静脉溶栓急性缺血性脑卒中患者预后的预测价值 [J ] . 热带医学杂志 , 2021 , 21 ( 10 ): 1323 ‑ 1326 .

LI J L , SUN L Y , LAI Z G , et al . The prognostic value of combined detection of serum total bilirubin and iNOS in acute ischemic stroke patients with rt‑PA intravenous thrombolysis [J ] . J Trop Med , 2021 , 21 ( 10 ): 1323 ‑ 1326 .

王思琪 , 冯锦文 , 孟强 . 脑梗死出血转化生物学标志及预测研究进展 [J ] . 重庆医科大学学报 , 2021 , 46 ( 5 ): 526 ‑ 528 .

WANG S Q , FENG J W , MENG Q . Advances in research on biomarkers and prediction of cerebral infarction hemorrhage transformation [J ] . J Chongqing Med Univ , 2021 , 46 ( 5 ): 526 ‑ 528 .

滕雨明 , 韩广淞 , 沙宇惠 , 等 . 血浆D‑二聚体水平与急性缺血性脑卒中病因分型、严重程度及预后的相关性研究 [J ] . 中风与神经疾病杂志 , 2022 , 39 ( 5 ): 388 ‑ 393 .

TENG Y M , HAN G S , SHA Y H , et al . The relationship between plasma D‑dimer levels and etiological classification, severity and outcome of acute ischemic stroke [J ] . J Apoplexy Nerv Dis , 2022 , 39 ( 5 ): 388 ‑ 393 .

陈楠 , 朱人定 , 刘雪云 , 等 . 急性脑梗死溶栓后出血转化患者血清胆红素水平变化观察 [J ] . 山东医药 , 2022 , 62 ( 15 ): 44 ‑ 48 .

CHEN N , ZHU R D , LIU X Y , et al . Changes in serum bilirubin in hemorrhagic transtofmation patients after treatment of intravenous thrombolysis for acute ischemic stroke [J ] . Shandong Med J , 2022 , 62 ( 15 ): 44 ‑ 48 .

刘莉 , 周依林 , 邢雪梅 . 尿素氮与白蛋白比值对老年急性脑梗死患者病情、预后的评估意义 [J ] . 中国老年学杂志 , 2023 , 43 ( 7 ): 1560 ‑ 1563 .

LIU L , ZHOU Y L , XING X M . Significance of the ratio of urea nitrogen to albumin in evaluating the condition and prognosis of elderly patients with acute cerebral infarction [J ] . Chin J Gerontol , 2023 , 43 ( 7 ): 1560 ‑ 1563 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Changes in serum circ_0003204 and miR‑532‑3p levels in acute cerebral infarction patients and their correlation with inflammatory factor levels

The Relationship between the Prognosis and the Parameters of the Liver Function of the Patients with Severe Viral Hepatitis (With 69 Cases Report)

Construction and validation of the prediction model for survival prognosis of idiopathic pulmonary fibrosis

Efficacy and safety of laparoscopic modified non⁃mesh iliopubic ligament suspension in the treatment of pelvic organ prolapse

Advances in health education for venous thromboembolism prevention

Related Author

LIU Yan

CHEN Shuo

HAO Xumiao

MA Haifeng

HAO Guang

Tan Chenghua

YANG Shuang

JIANG Hongxia

Related Institution

Department of Neurology, The First Affiliated Hospital of Hebei North University

Department of Infections Diseases,First Affiliated Hospital,Hubei Medical College

Department of Respiratory and Critical Care Medicine， Zhongnan Hospital of Wuhan University

Clinical Laboratory, Renmin Hospital of Wuhan University

Department of Oncology and Hematology, The Third People's Hospital of Hubei Province Affiliated to Wuhan University of Science and Technology

AI问答

⁰