| Abstract: | 研究背景: 腦血管疾病(Cerebrovascular disease)為一般民眾所知的「腦中風」，衛生福利部統計公佈2017年台灣國人十大死因，位居台灣第四位，腦血管疾病主要分為2大類，分別為缺血性腦中風(又稱腦梗塞；Ischemic stroke)及出血性腦中風(又稱腦溢血；Hemorrhagic Stroke)，其中70%多數為缺血性腦中風。近年來腦中風已逐漸有年輕化的趨勢，顯示腦中風已經不是老年人的疾病。2003年11 月衛生署正式核可健保給付，以靜脈內注射組織漿素原活化劑（recombinant t-PA,Actilyse）治療發作3 小時內的缺血性腦中風病患，因此使患者能快速被診斷出，且正確地接受診治，顯得格外的重要。
研究目的: 本研究主要在分析急診缺血性腦中風的患者，在急性發作期，發生發炎症狀，探討血液血凝檢驗與急診缺血性腦中風之間的關聯是否具有統計學上的意義，以增加未來在臨床上對缺血性腦中風可協助快速診斷，進而縮短接受治療時效。
研究方法: 此研究所使用之病人檢體是收集於2018年6月至2018年11月由台大醫院雲林分院急診醫學部，經判斷缺血性腦中風為收案對象，對照組為一般健康的人，進行血液血凝檢驗分析PT、INR、APTT、D-Dimer、Fibrinogen、ESR、WBC、PLT、PDW、MPV、P-LCR及PCT之檢驗數據做統計分析，了解血液血凝檢驗項目在缺血性腦中風中的檢驗價值。
結果: 發現D-Dimer、ESR、WBC及PCT在缺血性腦中風與健康人對照組間具有關聯性（p < 0.05），並探討發現ESR與Fibrinogen之間在缺血性腦中風具有正相關的關係，進一步以ROC統計分析， WBC AUC面積為0.750，在缺血性腦中風的診斷價值上，具有可接受的鑑別力，而D-Dimer AUC面積為0.851，在缺血性腦中風的診斷價值上，具有極佳的鑑別力，因此D-Dimer有助於臨床上對缺血性腦中風可協助快速診斷。
Background: Cerebrovascular diseases, among which stroke is the most widely known to the general public, were ranked fourth among the top 10 causes of death in Taiwan by the Ministry of Health and Welfare in 2017. Strokes can be divided into ischemic and hemorrhagic strokes, with the majority of cases (70%) being ischemic strokes. The ages of patients with stroke have become younger in recent years, indicating that stroke is no longer a disease primarily limited to older adults. In November 2003, the Department of Health and Welfare officially approved intravenous injection of recombinant t-PA (Actilyse)for use on Taiwan’s National Health Insurance to treat patients within 3 hours of the occurrence of ischemic stroke. Rapid diagnosis and correct treatment of patients with stroke is therefore vital if this treatment is to be used effectively.
Objective: The focus of this study was patients with emergency ischemic stroke who displayed inflammatory symptoms during the acute attack period. The statistical significance of the correlation between blood coagulation test results and emergency ischemic stroke was investigated to improve rapid clinical diagnosis of ischemic stroke, thereby shortening the time between disease occurrence and treatment.
Materials and methods: The patients in this study were recruited from the emergency department of National Taiwan University Hospital’s Yunlin Branch between June and November 2018.Recruitment was based on the assessments determined their conditions to be ischemic stroke ; average healthy individuals served as a control group. Blood coagulation testing was conducted on both groups to analyze the PT, INR, APTT, D-D, Fibrin,ESR, WBC, PLT, PDW, MPV, P-LCR, and PCT values of each blood coagulation item in ischemic stroke.
Results: A correlation was found between the levels of D-Dimer, ESR, WBC, and PCT in the patients with ischemic stroke and in the control group (p < 0.05). And there was a positive correlation between ESR and Fibrinogen in ischemic stroke.Further statistical analysis using the receiver operating characteristic curve showed that the area under the curve for WBC was 0.750, exhibiting an acceptable discriminating power for ischemic stroke diagnosis; moreover, the area under the curve for D-Dimer was 0.851, indicating excellent discriminating power for ischemic stroke diagnosis. Therefore, D-Dimer level can be used to help rapid clinical diagnosis of ischemic stroke. |
