高纤维蛋白原和高血糖的联合作用与急性缺血性脑卒中患者不良预后分析  

Evaluation between the combined effects of elevated fibrinogen and hyperglycemia and poor prognosis of patients with acute ischemic stroke

作　　者：许佳 冯安琪 王嘉敏 孙宏巍[2] 汤颖[2] 赵景波 XU Jia;FENG An-qi;WANG Jia-min;SUN Hong-wei;TANG Ying;ZHAO Jing-bo(Department of Epidemiology,School of Public Health,Harbin Medical University,Harbin 150081,China;Department of Emergency Neurology,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学公共卫生学院流行病学教研室,黑龙江哈尔滨150081 [2]哈尔滨医科大学附属第一医院急诊神经内科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2022年第1期72-75,79,共5页Journal of Harbin Medical University

基　　金：国家自然科学基金资助项目(81771508)。

摘　　要：目的 探讨高纤维蛋白原和高血糖的联合作用对急性缺血性脑卒中患者的预后影响。方法 选取2016年4月~2019年12月在哈尔滨医科大学附属第一医院神经内科收治的急性缺血性脑卒中患者1 515例建立队列,隔夜空腹测定患者血浆中的纤维蛋白原及葡萄糖水平,追踪患者出院、3个月、6个月和12个月的预后情况。采用Logistic回归分析高纤维蛋白原与高血糖的联合作用与急性缺血性脑卒中预后的关系。结果 以出院和不同随访时纤维蛋白原(-)血糖(-)为基准,调整混杂因素后,单独纤维蛋白原异常增加(高纤维蛋白原(+)血糖(-))并不是在每一个随访时间点对预后都增加不良风险,出院OR=1.27,95%CI:0.87~1.99;3个月OR=1.54,95%CI:1.01~2.36;6个月OR=1.48,95%CI:0.93~2.37;12个月OR=1.19,95%CI:0.71~2.01。单独血糖异常增加(纤维蛋白原(-)高血糖(+))在每一个时间点上对预后都增加不良风险,出院OR=2.04,95%CI:1.45~2.87;3个月OR=2.03,95%CI:1.45~2.82;6个月OR=1.97,95%CI:1.37~2.85;12个月OR=1.99,95%CI:1.35~2.94。而同时出现高纤维蛋白原和高血糖时(高纤维蛋白原(+)高血糖(+)),高纤维蛋白原在出院时(OR=2.37,95%CI:1.33~4.20)、3个月(OR=3.04,95%CI:1.76~5.25)和6个月(OR=2.32,95%CI:1.29~4.19)增大了高血糖对不良预后的危险性,12个月时(OR=1.65,95%CI:0.87~3.13)却降低了高血糖对不良预后的危险性。结论 高水平纤维蛋白原与高血糖的联合作用,增加急性缺血性脑卒中患者6个月内预后出现不良结局的风险,并且超过高血糖的单独作用,在12个月时却降低高血糖对预后不良结局的影响。Objective To explore the combined effect of elevated fibrinogen and hyperglycemia on the clinical prognosis of acute ischemic stroke patients. Methods A total of 1 515 hospitalized acute ischemic stroke patients in the Department of Emergency Neurology of the First Affiliated Hospital of Harbin Medical University from April 2016 to December 2019 were recruited. Plasma fibrinogen and glucose levels of acute ischemic stroke patients were measured after fasting overnight and the prognosis at discharge, 3-, 6-and 12-month was tracked. Logistic regression models were constructed to analyze the relationship between the combined effect of elevated fibrinogen, hyperglycemia and acute ischemic stroke patients’ prognosis. Results Discharge and follow-up outcomes of fibrinogen(-) glycemia(-) were used as the baseline, after adjusting for confounding factors, elevated fibrinogen alone(hyperfibrinogen(+) glycemia(-)) did not increase the risk of adverse outcomes at each follow-up time point, and the OR(95%CI) was 1.27(0.87~1.99), 1.54(1.01~2.36), 1.48(0.93~2.37) and 1.19(0.71~2.01) at discharge, 3-, 6-and 12-month follow-up, respectively. Hyperglycemia alone(fibrinogen(-) glycemia(+)) increased the risk of adverse outcome at each time point, and the OR(95%CI) was 2.04(1.45~2.87), 2.03(1.45~2.82), 1.97(1.37~2.85) and 1.99(1.35~2.94) at discharge, 3-, 6-and 12-month follow-up, respectively. However, the combined effect of elevated fibrinogen and hyperglycemia(hyperfibrinogen(+) hyperglycemia(+)), fibrinogen at discharge(OR=2.37, 95%CI: 1.33~4.20), 3-month(OR=3.04, 95%CI: 1.76~5.25) and 6-month(OR=2.32, 95%CI: 1.29~4.19) follow-up increased the risk of poor prognosis of hyperglycemia. At 12-month follow-up, fibrinogen reduced the risk of adverse prognosis of hyperglycemia with OR(95%CI) of 1.65(0.87~3.13). Conclusion The combined effect of elevated fibrinogen and hyperglycemia may increase the risk of prognosis in acute ischemic stroke patients within 6 months than hyperglycemia alone, and the risk of adverse prognosis of hype

关 键 词：纤维蛋白原 高血糖 联合效应 预后 急性缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]