脑梗死急性期血浆纤维蛋白原水平与预后的随诊观察  

Plasma fibrinogen in acute phase of cerebral infarction

作　　者：朱以诚[1] 崔丽英[1] 华宝来[1] 潘家绮[1] 范连凯[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经科,北京100730

出　　处：《中风与神经疾病杂志》2006年第2期223-225,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的了解脑梗死急性期血浆纤维蛋白原水平(fibrinogen,FIB)的影响因素,评价急性期FIB水平与脑梗死预后的相关性。方法选取自2000年1月～2002年5月在北京协和医院神经科住院治疗的116例脑梗死患者,应用凝血酶法(Clauss法)定量测定起病10d内血浆FIB水平,并对患者进行随访分析。通过线形回归分析评价急性期血浆FIB水平的影响因素。应用Kaplan—Meier法计算累积生存概率,分析急性期血浆FIB水平与脑梗死患者复发和死亡事件的相关性。结果临床分型为腔隙性脑梗死的患者血浆FIB(2．78±0．76g／L)浓度显著低于其他类型脑梗死患者(3．30±1．05g／L),且这一差异不受性别、糖尿病、高血压、吸烟、饮酒、病灶大小、感染等因素影响 (t=4．030,P<0．005)。病灶小于2cm的脑梗死中,大、小血管病变患者的血浆FIB浓度无显著差别(2．78±0．72g／ L比2．95±0．77g／L,P=0．478)。急性期FIB浓度高的患者(FIB浓度为前25百分位)病后1年时的预后较FIB低者(FIB浓度在后75百分位)差,前者复发和死亡事件概率(19．2％)高于后者(6．3％),P=0．047。远期的预后情况在两组间无明显差异(23．1％比14．3％,P=0．19)。结论脑梗死急性期FIB水平在不同类型脑梗死间存在差异, 且与1年内脑梗死复发或死亡事件相关。Objective To evaluate the levels of plasma fibrinogen in acute phase of cerebral infarction （CI） and the difference of fibrinogen levels among subtypes of CI. To assess the association between fibrinogen and prognosis of ischemic stroke. Methods 116 acute ischemic stroke patients who were hospitalized in PUMCH from Jan 2000 to May 2002 were recruited. Plasma fibrinogen levels within 10 days after stroke onset were determined by the Clauss method. Factors related to acute phase plasma fibrinogen were analyzed by liner regression. Kaplan Meier survival curves were graphed to investigate the association between plasma fibrinogen level in acute phase and relapse or death event. Results After adjusting for gender,diabetes,hypertension.smoke,alcohol drinking.le sion diameter and infection,the fibrinogen level（2.78±0.76g/L） of LACI were significantly lower than those of patients with other subtypes of cerebral infarction（3.30±1.05g/L） （P〈0. 005）. Among patients whose infarct ion were smaller than 2cm in diameter,there were no difference in plasma fibrinogen between large vessel disease and small vessel disease（2.78±0.72g/L vs 2.95±0.77g/L.P=0.478）. 1 year after onset,the probability of survival without reocurrence among patients whose fibrinogen levels were at the highest quartile were less than those with fibrinogen at the lower 75 percent（80. 8% vs 93.7%）,P=0.047. But this difference was disappeared 1 year latter （76. 9% vs 85. 7%, P= 0. 19）. Conclusions There might be difference in plasma fibrinogen among subtypes of cerebral infarction. High fibrinogen levels in acute phase might predict reocurrence or death of cerebral infarction within 1 year.

关 键 词：脑梗死 纤维蛋白原 

分 类 号：R743[医药卫生—神经病学与精神病学]