血清D-二聚体、NLR联合CTP对急性脑梗死溶栓后出血转化的评估价值

D-dimer, NLR combined with CTP for hemorrhagic transformation after thrombolysis in acute cerebral infarction

摘要:

目的 探究血清D-二聚体（D-D）、中性粒细胞与淋巴细胞比值（NLR）联合CT灌注成像（CTP）对急性脑梗死（ACI）溶栓后出血转化的评估价值。方法 选取2022年2月—2025年3月阜阳市人民医院收治的100例ACI患者，根据是否溶栓后出血转化分为非出血组（74例）和出血组（26例）。比较两组一般资料及血清D-D、NLR的表达，并根据CTP图像分析相关参数。采用多因素一般Logistic回归模型分析ACI患者溶栓后出血转化的影响因素，绘制受试者工作特征（ROC）曲线分析血清D-D、NLR联合CTP对ACI患者溶栓后出血转化的预测价值。结果 出血组的心源性栓塞型占比、收缩压、大面积梗死占比、NIHSS评分、D-D水平、NLR均高于非出血组（P <0.05）。出血组的相对脑血流量（rCBF）、相对脑血容量（rCBV）低于非出血组，相对达峰时间（rTTP）高于非出血组（P <0.05）。多因素一般Logistic回归分析结果显示，梗死面积、收缩压、NIHSS评分、D-D、NLR、rCBF、rCBV、rTTP是ACI患者溶栓后出血转化的影响因素（P <0.05）。ROC曲线分析结果表明，血清D-D、NLR、CTP联合预测的曲线下面积为0.951（95% CI：0.882，1.000），敏感性为96.2%（95% CI：0.804，0.999），特异性为93.2%（95% CI：0.849，0.978）。结论 血清D-D、NLR联合CTP对ACI患者溶栓后出血转化有着良好的预测价值。

Abstract:

Objective To explore the predictive value of serum D-dimer (D-D), neutrophil-to-lymphocyte ratio (NLR), and CT perfusion imaging (CTP) in assessing hemorrhagic transformation after thrombolytic therapy in patients with acute cerebral infarction (ACI).Methods A total of 100 ACI patients admitted to Fuyang People's Hospital from February 2022 to March 2025 were enrolled and divided into a non-hemorrhagic group (n = 74) and a hemorrhagic group (n = 26) based on the presence or absence of post-thrombolytic hemorrhagic transformation. General clinical data and serum levels of D-D and NLR were compared between groups. Relevant CTP parameters were analyzed through image processing. Logistic regression analysis was performed to identify influencing factors of hemorrhagic transformation. The predictive value of D-D, NLR, and CTP, alone and in combination, was evaluated using receiver operating characteristic (ROC) curve analysis.Results The hemorrhagic group had higher proportions of cardioembolic infarction, large infarct size, elevated systolic blood pressure, higher NIHSS scores, and increased levels of D-D and NLR compared to the non-hemorrhagic group (P < 0.05). Relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) were significantly lower, while relative time-to-peak (rTTP) was higher in the hemorrhagic group (P < 0.05). Logistic regression revealed that infarct size, systolic blood pressure, NIHSS score, D-D, NLR, rCBF, rCBV, and rTTP were independent risk factors for hemorrhagic transformation (P < 0.05). The ROC curve analysis results indicated that the area under the curve for the combined prediction of serum D-D, NLR, and CTP was 0.951 (95% CI: 0.882, 1.000), with a sensitivity of 96.2% (95% CI: 0.804, 0.999) and a specificity of 93.2% (95% CI: 0.849, 0.978).Conclusion Serum D-D and NLR combined with CTP provide a valuable predictive approach for hemorrhagic transformation after thrombolysis in patients with ACI.