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題名 | 從血液中D-dimer濃度預測外傷性腦出血及非外傷性腦出血的可能預後=The Predictive Outcome of Blood D-Dimer in Traumatic and Non-Traumatic Intracranial Hemorrhage |
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作者 | 郭進榮; 林高章; 林宏榮; 王哲川; 楊浚銘; 張偉倫; Kuo, Jinn-rung; Lin, Kao-chang; Lin, Hung-jung; Wang, Che-chuan; Yang, Chin-ming; Chang, Wei-lun; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20060000 |
卷期 | 8:2 民95 |
頁次 | 頁49-58 |
分類號 | 415.92 |
語文 | chi |
關鍵詞 | D-dimer濃度; 外傷性腦出血; 非外傷性腦出血; D-dimer level; Traumatic and non-traumatic ICH; |
中文摘要 | 目的:急性外傷性腦出血(Intracranial hemorrhage-ICH)及非外傷性腦出血與血液中D-dimer的濃度具有關聯性。然而對於D-dimer濃度的高低與初始意識狀態(Glasgow coma scale-GCS),瞳孔反應(pupil reactive),顱内電腦斷層中線偏移距離(distance of midline shift on brain computed tomography-CT),及3個月預後指標評估(Glasgow Outcome Scale-GOS)的相關情形,並沒有研究提到。 方法:從2005年1~12月中,共98位外傷性腦出血及59位非外傷性出血的病人被收錄於我們研究當中。病患有先前之深部靜脈阻塞、血液疾病、最近曾經接受大手術者、服用藥物(例如aspirin, coumadin)、年紀大於75歲、及合併腫瘤者於收案時先被排除。D-dimer濃度於病患發生神經症候,在送至急診中之數小時内完成抽血定量之。利用統計方式,如Wilcoxon rank-sum試驗,Spearman's試驗,及Kruskal-Wallis試驗併隨Dunn試驗來分析所要測量的結果。 結果:D-dimer濃度和初始意識狀態(ρ=-0.553, P<0.001),電腦斷層中線偏移距離(ρ=0.551, P<0.001),瞳孔反應(ρ=-0.572, P<0.001),及3個月預後指標評估(ρ=-0.686, P<0.001),在外傷性腦出血患者呈現顯著性相關,但對於非外傷性出血患者呈現不顯著性影響。利用接收器運作指標曲線(Receiver Operating Characteristic curve-ROC),區分上述外傷性及非外傷性出血的切入點,最佳指數約為294μg/L。在此切分點上其敏感度為79.6%,專一性為86.4%。 結論:高數值的血液中D-dimer濃度與外傷性腦出血的預後及嚴重度呈現相關性,但對於非外傷性腦出血卻沒有定論。D-dimer可以作為區分上述兩者的一個參考工具,且具有可靠的信賴度。然而,單獨使用該數值來區分或判讀出血的預後,則必須小心謹慎。 |
英文摘要 | Objectives: Acute traumatic intracranial hemorrhage (ICH) and non-traumatic ICH have been correlated to high D-dimer level in previous studies. However, the correlations between D-dimer and Glasgow coma scale (GCS), pupilary light reflex, degree of midline shift on brain computed tomography (CT), and Glasgow Outcome Scale (GOS) have not been studied. Methodology: From January to December in 2005, a total of 98 traumatic ICH and 59 non-traumatic ICH were selectively enrolled for study. Patients with preexisting deep venous thrombosis, blood idiosyncrasy, major surgery, drug use (i.e., aspirin, coumadin), elderly, or co-morbid with malignancy affecting the coagulopathy were excluded. The D-dimer level was estimated within hours after insult in the emergency room. The Wilcoxon rank-sum test, Spearman's test and Kruskal-Wallis test followed by Dunn test were used for statistical analysis. Results: the initial GCS scale (ρ=-0.553, P<0.001), the middine shift on brain CT (ρ=0.551, P<.001), the papillary reflex (ρ=-0.572, P<0.001), and the GOS by 3 months (ρ=-0.686, P<0.001) are significantly correlated with higher D-dimer level in traumatic group, but not in non-traumatic subjects. Using Receiver Operating Characteristic curve (ROC), the better cutoff point of D-dimer value in distinguishing both is approximately 294 μg/L, of which the sensitivity and specificity was 79.6% and 86.4%. Conclusions: The higher D-dimer level is associated with the severity and poor outcome in traumatic ICH patients, but was inconclusive in non-traumatic group. It can be used as a marker to differentiate between traumatic and non-traumatic ICH with a reliable validity. Yet, it should be careful interpretation using D-dimer alone to determinate the outcome in ICH patients. |
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