【摘要】 目的 分析D-二聚体/血小板计数比值（DPR）对老年性动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血的预测效能。方法 选择2020年5月至2024年5月收治的152例老年性aSAH患者作为观察组，并根据迟发性脑缺血发生情况分为发生组（n=45）和未发生组（n=107）。将139例同期健康体检人群作为对照组。纳入研究者均检测外周血D-二聚体（D-D）、血小板水平，并计算DPR。采用受试者工作特征（ROC）曲线评估DPR对老年性aSAH后迟发性脑缺血的预测价值，多因素logistic回归分析影响老年性aSAH后迟发性脑缺血发生的相关因素。结果 观察组血清D-D、DPR水平均高于对照组，血小板水平低于对照组（P<0.05）。发生组Hunt-Hess分级≥3级患者占比及血清D-D、DPR、白细胞、缺氧诱导因子-1α(HIF-1α)、白细胞介素-6(IL-6)及凝血酶原时间、活化部分凝血活酶时间高于未发生组，血小板水平低于未发生组（P<0.01）。ROC曲线分析结果显示，DPR预测老年性aSAH后迟发性脑缺血的曲线下面积为0.901(95%CI:0.852,0.952)。多因素logistic回归分析显示，Hunt-Hess分级[OR(95%CI):2.721(1.647,4.494)]、HIF-1α[OR(95%CI):2.349(1.553,3.552)]、IL-6[OR(95%CI):2.106(1.466,3.027)]、DPR[OR(95%CI):3.504(1.890,6.497)]均为影响老年性aSAH后迟发性脑缺血发生的相关因素（P<0.01）。结论 DPR在老年性aSAH后迟发性脑缺血患者中异常升高，是老年性a SAH迟发性脑缺血发生的危险因素，有望作为预测aSAH患者迟发性脑缺血发生的有效指标。更多还原

【Abstract】 Objective To analyze the predictive efficacy of D-dimer/platelet ratio(DPR) for delayed cerebral ischemia(DCI) after aneurysmal subarachnoid hemorrhage(aSAH) in elderly patients. Methods A total of 152 elderly patients with aSAH admitted to our hospital from May 2020 to May 2024 were selected as the research group, and then divided into the observation group(n=45) and the non-occurrence group(n=107) according to the occurrence of DCI. In addition, 139 healthy physical examinees during the same period were selected as the control group. The levels of D-dimer(D-D) and platelet count(PLT) in peripheral blood of both groups were detected after admission, and the DPR ratio was calculated. The receiver operating characteristic curve(ROC) was used to evaluate the predictive value of DPR for DCI after aSAH in the elderly. Multivariate logistic regression analysis was used to explore the related factors for the occurrence of DCI after aSAH in the elderly. Results The levels of serum D-D and DPR in the observation group were higher than those in the control group, while the level of PLT was lower than that in the control group(P<0.05). The proportion of patients with Hunt-Hess grade≥3, serum D-D, DPR, white blood cell, hypoxia-inducible factor-1α(HIF-1α), interleukin-6(IL-6), prothrombin time(PT), and activated partial thromboplastin time(APTT) in the observation group were higher than those in the non-occurrence group, while the PLT level was lower in the observation group than in the non-occurrence group(P<0.01). The results of ROC curve showed that the area under the ROC curve(AUC) of DPR for predicting DCI after aSAH in the elderly was 0.901(95%CI: 0.852, 0.952). Multivariate logistic regression analysis showed that Hunt-Hess grade [OR(95%CI): 2.721(1.647, 4.494)], HIF-1α [OR(95%CI): 2.349(1.553, 3.552)], IL-6 [OR(95%CI): 2.106(1.466, 3.027)] and DPR[OR(95%CI): 3.504(1.890, 6.497)] were related factors affecting the occurrence of DCI after aSAH in the elderly(P<0.01). Conclusions The abnormal increase of DPR in elderly patients with DCI after aSAH is a risk factor for DCI in elderly patients with aSAH. DPR is expected to be an effective index for predicting DCI in patients with aSAH.更多还原