D-二聚体在颅内静脉窦血栓形成
诊治中的研究进展

摘要/Abstract

摘要：

D-二聚体是交联纤维蛋白在纤溶酶作用下产生的一种特异性降解产物。既可反映凝血酶的活性，又可反映纤溶酶的活性。近年来大量研究表明，D-二聚体在颅内静脉窦血栓形成中普遍升高，有助于早期诊断颅内静脉窦血栓形成，因此D-二聚体异常升高提示颅内静脉窦血栓形成可能，但D-二聚体正常能否除外颅内静脉窦血栓形成仍存在争议。本文就D-二聚体和颅内静脉窦血栓形成的关系，D-二聚体在颅内静脉窦血栓形成的早期诊断、治疗及预后判断中的临床意义做一综述，以期指导临床。

文章导读： 本文通过对D-二聚体的定义及形成进行介绍，阐述了D-二聚体在颅内静脉窦血栓形成早期诊断、
排除诊断、治疗及预后判断中的临床应用价值及意义。

关键词: 颅内静脉窦血栓形成; D-二聚体; 诊断

Abstract:

D-dimer is a specific crosslinked fibrin degradation product generated in the action of plasmin. It can not only reflect the activity of thrombin, but also plasmin activity. In recent years, numerous studies have demonstrated that D-dimer increased in the majority of patients with cerebral venous sinus thrombosis (CVST) and it is helpful in its early diagnosis. Abnormally elevated D-dimer may prompt CVST, but whether normal D-dimer can exclude CVST remains controversial. This paper describes the relationship between D-dimer and CVST, and discusses the clinical significance of D-dimer played in the early diagnosis of CVST, treatment and prognosis.

Key words: Cerebral venous sinus thrombosis; D-dimer; Diagnosis

陈丹莉，吐尔逊·沙比尔，张祥. D-二聚体在颅内静脉窦血栓形成
诊治中的研究进展[J]. 中国卒中杂志, 2014, 9(10): 860-863.

CHEN Dan-Li, TUERXUN Shabier,ZHANG Xiang.. Research Progress in the Diagnosis and Treatment of D-dimer in Cerebral Venous
Sinus Thrombosis[J]. Chinese Journal of Stroke, 2014, 9(10): 860-863.

参考文献

1 杨金波, 李如娟, 吉训明. 脑静脉窦血栓形成病因分析

[J]. 河北医科大学学报, 2010, 31:1375-1378.

2 Smith FB, Lee AJ, Fowkes FG, et al. Haemostatic

factors as predictor of ischaemic heart disease and

stroke in Edinburgh artery study[J]. Arterioscler

Thromb Vasc Biol, 1997, 17:3321-3325.

3 Panchenenko E, Dobrovoasky A, Davktov k, et al.

D-dimer and fibrinolysis in patients with various

degrees of atherosclerosis[J]. Eur Heart J, 1995, 16:38-

42.

4 Salvioni A, Marenzi G, Agostoni P, et al. Influence

of hepar in on f ibr inogen and D-dimer plasma

levels in acute myocardial infarction treated with

streptokinase[J]. Eur Heart J, 1994, 15:654-659.

5 Dentali F, Squizzato A, Marchesi C, et al. D-dimer

testing in the diagnosis of cerebral vein thrombosis:a

systematic review and a met a-analysis of the

literature[J]. J Thromb Haemost, 2012, 10:582-589.

6 刘自勤, 李小磊, 薛文俊. D-二聚体在颅内静脉窦血栓

形成中的临床意义[J]. 临床医学, 2013, 33:48-50.

7 李丹丹, 马聪. D-二聚体检测的临床应用进展[J]. 血栓

与止血学, 2011, 17:138-144.

8 赵伯翔, 顾建平. D-二聚体在静脉血栓栓塞症中的应用

[J]. 医学综述, 2014, 20:218-222.

9 吴海蓉. D-二聚体在肺部疾病应用中的研究进展[J].

中华肺部疾病杂志, 2013, 6:170-172.

10 严广东. D-二聚体检测的临床应用新进展[J]. 医学综

述, 2014, 20:627-630.

11 Meng R, Dornbos D 3rd, Meng L, et al. Clinical

differences between acute CVST and non-thrombotic

CVSS[J]. Clin Neurol Neurosurg, 2012, 144:1257-

1262.

12 Lalive PH, de Moerloose P, Lovblad K, et al. Is

measurement of D-dimer useful in the diagnosis of

cerebral venous thrombosis?[J]. Neurology, 2003,

61:1057-1060.

13 Kosinski MD, Mull M, Schwarz M, et al. Do normal

D-dimer levels reliably exclude cerebral sinus

thrombosis?[J]. Stroke, 2004, 35:2820-2825.

14 Darji Z, Dabhi L. A study of 25 cases of cerebral

venous sinus thrombosis[J]. Int J Med Sci Public

Health, 2014, 3:581-584.

15 Piazza G. Cerebral venous thrombosis[J]. Circulation,

2012, 125:1704-1709.

16 Talbot K, Wright M, Keeling D. Normal D-dimer

levels do not exclude the diagnosis of cerebral venous

sinus thrombosis[J]. J Neurol, 2002, 249:1603-1604.

17 Vatankhah B, Fürst A, Schlachetzki F. Do normal

D-Dimer levels reliably exclude cerebral sinus

thrombosis? A solution of problems?[J]. Stroke, 2005,

36:2528-2529.

18 Crassard I, Soria C, Tzourio C, et al. A negative

D-dimer assay does not rule out cerebral venous

thrombosis:a series of seventy-three patients[J].

Stroke, 2005, 36:1716-1719.

19 Sidhom Y, Mansour M, Messelmani M, et al. Cerebral

venous thrombosis:clinical features, risk factors, and

long-term outcome in a Tunisian cohort[J]. J Stroke

Cerebrovasc Dis, 2014, 23:1291-1295.

20 Ferro JM, Canhão P. Acute treatment of cerebral

venous and dural sinus thrombosis[J]. Curr Treat

Options Neurol, 2008, 10:126-137.

21 Masuhr F, Einhäupl K. Treatment of cerebral venous

and sinus thrombosis[J]. Front Neurol Neurosci, 2008,

23:132-143.

22 Weimar C. Diagnosis and treatment of cerebral

venous and sinus thrombosis[J]. Curr Neurol Neurosci

Rep, 2014, 14:417.

23 Einhäupl K, Bousser MG, Bruijn SF, et al. EFNS

guideline on the treatment of cerebral venous and

sinus thrombosis[J]. Eur J Neurol, 2006,13:553-559.

24 门剑龙, 任静. D-二聚体临床应用及标准化分析进展

[J]. 中华检验医学杂志, 2010, 33:793-796.

25 靳毅, 邢辉, 王晓蓓. D-二聚体测定在血栓性疾病诊疗

中的应用[J]. 中华医学杂志, 2007, 87:2278-2280.

26 Hiltunena S, Putaala J, Haapaniemi E, et al. D-dimer

and clinicoradiologic features in cerebral venous

thrombosis[J]. J Neurol Sci, 2013, 327:12-14.

27 Misra UK, Kalita J, Bansal V. D-dimer is useful in

the diagnosis of cortical venous sinus thrombosis[J].

Neurol India, 2009, 57:50-54.

28 Wu C, Bates SM. Should D-dimer testing be used to

predict the risk of recurrence after discontinuation of

anticoagulant therapy for a first unprovoked episode

of venous thromboembolism?[J]. Pol Arch Med

Wewn, 2009, 119:225-230.

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