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

刘艳; 徐旭慧; 龚静; 陈硕

doi:10.14188/j.1671-8852.2023.0388

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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

临床医学研究 | 更新时间：2026-11-05

- 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
- Prognostic factors and predictive values of serum D‑dimer, bilirubin and urea nitrogen after thrombolysis in acute cerebral infarction
- 武汉大学学报（医学版） 2025年46卷第6期页码：749-753
- 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：
  
  刘艳，女，1989—，主治医师，主要从事脑梗死及眩晕方向研究，E‑mail：dllyhh2010@163.com
  陈硕，女，1991—，主治医师，主要从事脑梗死及眩晕研究， E‑mail：chenshuo_119@163.com
- 基金信息：
  
  2020年度江苏省药学会⁃天晴医院药学基金资助项目(苏药会字〔2020〕128号)
- DOI：10.14188/j.1671-8852.2023.0388
  中图分类号： R743.33
- 收稿：2023-07-12，
  
  纸质出版：2025-06-25
- 稿件说明：
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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

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