高纤维蛋白原血症与2型糖尿病合并急性脑梗死患者早期神经功能恶化的关系  

Relationship between elevated fibrinogen and early neurological deterioration in type 2 diabetes mellitus patients with acute cerebral infarction

作　　者：王翼 杜娜 王婷婷 Wang Yi;Du Na;Wang Tingting(Second Department of Health Care,No.971 Hospital of the PLA Navy,Qingdao 266000,China)

机构地区：[1]中国人民解放军海军第971医院保健二科,青岛266000

出　　处：《中华老年医学杂志》2022年第7期811-816,共6页Chinese Journal of Geriatrics

基　　金：青岛市卫生和计划生育委员会科研基金项目(2020WJZD195)。

摘　　要：目的探讨老年2型糖尿病(DM)患者急性脑梗死(ACI)后血浆纤维蛋白原(FIB)水平与早期神经功能恶化(END)的关系。方法纳入2018年1月至2019年12月我院神经内科收治的老年ACI患者136例作为研究对象,根据是否发生END,分为END组(38例)和非END组(98例),进行单因素和多因素评估FIB与END的关系。将老年ACI合并DM患者分为END组(18例)和非END组(26例),进行倾向评分匹配分析,匹配调整后将年龄、性别、高血压、TOAST分类和FIB进行Logistic回归多元分析。结果136例ACI患者中,有38例(27.9%)出现END,有98例(72.1%)未发生END。136例老年ACI患者中,END组在年龄[(62.3±2.4)岁和(59.2±1.8)岁,t=2.035,P=0.044]、高血压病史(76.3%和57.1%,χ^(2)=4.295,P=0.038)、糖尿病史(47.4%和26.5%,χ^(2)=5.433,P=0.020)、美国国立卫生院卒中量表评分(NIHSS)[(8.5±5.7)分和(6.1±4.6)分,t=2.548,P=0.012]、TOAST[大动脉粥样硬化(65.8%和40.8%),心源性栓塞(5.3%和10.2%),小动脉闭塞(23.7%和23.5%),其他(2.6%和20.4%),不明原因型(2.6%和5.1%),χ^(2)=10.314,P=0.035]、血糖[(8.89±1.28)mmol/L和(7.36±1.64)mmol/L,t=6.048,P=0.000]、FIB[(3.57±1.33)g/L和(3.07±1.14)g/L,t=2.236,P=0.027]水平方面明显高于非END组;多元回归分析显示较高的FIB水平与END无关(P>0.05)。基于倾向评分匹配分析44例老年ACI合并DM患者,匹配前END组患者高血压病史、NIHSS评分、FIB水平均明显高于非END组(均P<0.05),匹配后END组患者FIB水平高于非END组(P<0.05);多元回归分析显示,FIB与END显著相关。结论FIB水平增高与ACI合并DM患者的END的风险密切相关,具有较好的预测价值。Objective To investigate the relationship between plasma fibrinogen(FIB)levels and early neurological deterioration(END)in elderly patients with type 2 diabetes mellitus(DM)after acute cerebral infarction(ACI).Methods 136 ACI patients admitted to the neurology department of our hospital from January 2018 to December 2019 were included as study subjects.Patients were divided into an END group and a non-END group based on whether END occurred.Univariate and multivariate analyses were conducted to assess the relationship between FIB and END.Elderly patients with concurrent ACI and DM were divided into an END group(18 cases)and a non-END group(26 cases)for propensity score matching analysis.After matching adjustment,age,sex,hypertension,TOAST classification and FIB were analyzed by multivariate Logistic regression.Results Among 136 patients with ACI,38(27.9%)had END and 98(72.1%)did not have END and the END group had higher values or percentages than the non-END group in age[(62.3±2.4)ys and(59.2±1.8)ys,t=2.035,P=0.044],history of hypertension(76.3%and 57.1%,χ^(2)=4.295,P=0.038),history of diabetes(47.4%and 26.5%,χ^(2)=5.433,P=0.020),NIHSS score[(8.5±5.7)and(6.1±4.6),t=2.548,P=0.012],TOAST classification(large artery atherosclerosis:65.8%vs.40.8%,cardioembolism:5.3%vs.10.2%,small artery occlusion:23.7%vs.23.5%,other determined cause:2.6%vs.20.4%,undetermined cause:2.6%vs.5.1%,χ^(2)=10.314,P=0.035),blood glucose[(8.89±1.28)mmol/L and(7.36±1.64)mmol/L,t=6.048,P=0.000]and FIB level[(3.57±1.33)g/L and(3.07±1.14)g/L,t=2.236,P=0.027].Multiple regression analysis showed that higher FIB levels were not associated with END(P>0.05).Propensity score matching analysis of 44 patients with concurrent ACI and DM showed that history of hypertension,NIHSS score and FIB level before matching were significantly higher in the END group than in the non-END group(P<0.05)and FIB was higher in the END group than in the non-END group after matching.Multiple regression analysis showed that FIB was significantly associated with END.

关 键 词：糖尿病 2型 脑梗死 纤维蛋白原 

分 类 号：R587.2[医药卫生—内分泌] R743.33[医药卫生—内科学]