纤维蛋白原及脂蛋白(a)与伴糖尿病的急性缺血性卒中患者早期神经功能恶化的相关性  

Correlation between fibrinogen and lipoprotein(a)and early neurological deterioration in acute ischemic stroke patients with diabetes

作　　者：晏美娟 邵礼晖 Meijuan Yan;Lihui Shao(Department of Neurology,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属徐州市立医院神经内科,221002 [2]新沂市中医院,徐州221499

出　　处：《国际脑血管病杂志》2021年第10期732-737,共6页International Journal of Cerebrovascular Diseases

基　　金：中国矿业大学青年基金(2020QN83);徐州医科大学附属医院科技发展基金(XYFY2020034)。

摘　　要：目的探讨纤维蛋白原及脂蛋白(a)与伴糖尿病的急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性。方法回顾性纳入2017年1月至2020年12月期间在发病48 h内入住徐州医科大学附属徐州市立医院神经内科的急性缺血性卒中患者。END定义为发病后7 d内复评美国国立卫生研究院卒中量表(National Instiutes of Health Stroke Scale,NIHSS)评分最高分较入院时增加≥2分,或运动项评分增加≥1分。收集患者人口统计学和基线临床资料。应用多变量logistic回归分析确定总体和伴糖尿病的急性缺血性卒中患者END的独立危险因素。结果共纳入1504例急性缺血性卒中患者,252例(16.76%)发生END。END组患者年龄显著较大,糖尿病患者构成比以及基线NIHSS评分、随机血糖、纤维蛋白原和脂蛋白(a)水平较高,病因学分型也与非END组存在显著差异(P均<0.05)。多变量logistic回归分析显示,纤维蛋白原和脂蛋白(a)水平并非END的独立危险因素。337例患者合并糖尿病,其中85例发生END(25.22%)。END组纤维蛋白原及脂蛋白(a)水平显著高于非END组(P均<0.05)。多变量logistic回归分析显示,纤维蛋白原(优势比2.23,95%置信区间1.75~4.54;P=0.002)和脂蛋白(a)(优势比1.98,95%置信区间1.57~3.65;P=0.003)均为END的独立危险因素。结论纤维蛋白原及脂蛋白(a)较高与伴糖尿病的急性缺血性卒中患者END相关。Objective To investigate the correlation between fibrinogen and lipoprotein(a)and early neurological deterioration(END)in acute ischemic stroke patients with diabetes.Methods From January 2017 to December 2020,patients with acute ischemic stroke admitted to the Department of Neurology,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 48 h of onset were enrolled retrospectively.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score within 7 d after onset increased by≥2 or motor function score increased by≥1 compared with the baseline.Demographic and baseline clinical data were collected.Multivariate logistic regression analysis was used to identify the independent risk factors for END in general and diabetic patients with acute ischemic stroke.Results A total of 1504 patients with acute ischemic stroke were enrolled.Two hundred and fifty-two(16.76%)patients had END.The age,baseline NIHSS score,random blood glucose,fibrinogen,lipoprotein(a)levels,and the proportion of patients with diabetes in the END group were higher than those in the non-END group.There were also significant differences in various stroke etiologic subtypes between the END group and the non-END group(all P<0.05).Multivariate logistic regression analysis showed that fibrinogen and lipoprotein(a)levels were not the independent risk factors for END in patients with acute ischemic stroke.Three hundred and thirty-seven patients also had diabetes mellitus,of which 85 had END(25.22%).The levels of fibrinogen and lipoprotein(a)in the END group were significantly higher than those in the non-END group(P<0.05).Multivariate logistic regression analysis showed that fibrinogen(odds ratio 2.23,95%confidence interval 1.75-4.54;P=0.002)and lipoprotein(a)(odds ratio 1.98,95%confidence interval 1.57-3.65;P=0.003)were the independent risk factors for END in acute ischemic stroke patients with diabetes.Conclusion Higher fibrinogen and lipoprotein(a)levels are associated with END in acute ischemic stroke patients with

关 键 词：卒中 脑缺血 早期神经功能恶化 糖尿病 疾病恶化 纤维蛋白原 脂蛋白(a) 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R587.2[医药卫生—临床医学]