急性脑梗死患者血纤维蛋白原水平与预后关系的研究  

Correlation between hyperfibrinogenemia and long-term outcome in patients with acute braininfarction

作　　者：李慎军[1] 程明[1] 唐吉刚[1] 曹秉振[1] 

机构地区：[1]济南军区总医院神经内科,济南250031

出　　处：《中华神经医学杂志》2016年第2期177-182,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨血纤维蛋白原水平与急性脑梗死患者预后的关系。方法前瞻性收集自2010年8月至2014年8月于济南军区总医院神经内科住院的急性脑梗死患者，记录其年龄、性别、血清肌酐、美国国立卫生研究院卒中量表（NIHSS）评分、牛津郡社区卒中计划分型、人院24h内血纤维蛋白原水平等基线资料，并按血纤维蛋白原水平是否增高将患者分为高纤维蛋白原血症组和血纤维蛋白原正常组。在发病后180d时进行随访，采用改良Rankin量表（mRS）评分对患者预后进行评价（mRS评分≤2分为预后良好．mRS评分〉2分为预后不良）。采用多元Logistic回归分析、Kaplan-Meier生存曲线分析血纤维蛋白原水平对急性脑梗死患者不良预后和病死率的影响。结果共纳入495例急性脑梗死患者，其中高纤维蛋白原血症组123例、血纤维蛋白原正常组372例，预后不良组200例、预后良好组295例。与血纤维蛋白原正常组相比，高纤维蛋白原血症组预后不良比例高（34．41％vS．60．98％），差异有统计学意义（P〈0．05）。与预后良好组相比，预后不良组血纤维蛋白原水平更高[3．00（0．95）g／LVS．3．35（1．4）g／L]，差异有统计学意义（P〈0．05）。Spearman秩相关性分析结果显示．高纤维蛋白原血症与mRS评分存在相关性（r==0．219，P=0．026）。多元Logistic回归分析显示．高纤维蛋白原血症是急性脑梗死患者预后不良的独立预测因子（0R=1．772，95％CI：1．1003-3．130．P=-0．049）。Kaplan．Meier生存曲线显示，与血纤维蛋白原正常组相比，高纤维蛋白原血症组生存率更低（91．40％±76．42％），差异有统计学意义（P〈0．05）。结论发病24h内有高纤维蛋白原血症是急性脑梗死患者发病后180d时预后不良的独立预测因子。发病24h内有高纤维蛋白原向痒的急件脑梗死患者发病后180d内牛存率低．Objective To investigate the influence of hyperfibrinogenemia in outcome of patients with acute brain infarction. Methods Consecutive acute cerebral infarction patients, admitted to our hospital from August 2010 to August 2014, were prospectively recruited. The baseline data, including age, gender, serum creatinine level, National Institute of Health Stroke Scale （NIHSS） scores, types of Oxfordshire Community Stroke Project （OCSP： total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct and lacunar infarct）, and plasma fibrinogen level within 24 h of admission were recorded. Patients were divided into two groups according to with or without hyperfibrinogenemia. Recovery was assessed by modified Rankin Scale （mRS） 180 days after stroke by telephone interview （mRS 〈 2 reflected good prognosis, and mRS〉2 reflected unfavorable prognosis）. Multi-variant Logistic regression analysis and Kaplan-Meier curve analysis were performed to analyze the influence of fibrinogen in bad prognosis and mortality ratio. Results A total of 495 patients were enrolled, including 123 patients with hyperfibrinogenemia. Good prognosis was noted in 200 patients and bad one was noted in 295 patients. As compared with patients without hyperfibrinogenemia, acute ischemic patients with hyperfibrinogenemia had significantly higher rate of bad prognosis （34.41% vs.60.98%, P〈0.05）; as compared with patients with good prognosis, patients with bad prognosis had significantly higher fibrinogen （3.00[0.95] g/L vs. 3.3511.4] g/L, P〈0.05）. Spearman correlation analysis indicated that hyperfibrinogenemia was correlated to the mRS scores （r=0.219, P=-0.026）. Multivariate Logistic regression indicated that hyperfibrinogenemia within 24 hours since onset was an independent prognostic factor for long-term poor outcomes （OR=1.772, 95% CI： 1.1003-3.130, P=-0.049）. Kaplan-Meier estimate of patients with hyperfibrinogenemia for cumulative 180 days survival function for all-

关 键 词：纤维蛋白原:脑梗死 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]