红细胞与纤维蛋白成分在急性缺血性脑卒中患者血栓中的占比分析及其对预后的影响  

Proportion of red blood cells and fibrin components in thrombi of acute ischemic stroke patients and their impact on prognosis

作　　者：罗根培 胡伟东 钟望涛 Luo Gen-pei;Hu Wei-dong;Zhong Wang-tao(Graduate School,Guangdong Medical University,Zhanjiang,Guangdong 524000,China;Department of Neurology,Dongguan People's Hospital,Dongguan,Guangdong 523000,China;Department of Neurology,Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524000,China)

机构地区：[1]广东医科大学研究生学院,广东湛江524000 [2]东莞市人民医院神经内科,广东东莞523000 [3]广东医科大学附属医院神经内科,广东湛江524000

出　　处：《中国现代医学杂志》2025年第1期9-14,共6页China Journal of Modern Medicine

基　　金：广东省基础与应用基础研究基金(No:2021B1515120089)。

摘　　要：目的探讨红细胞与纤维蛋白成分在急性缺血性脑卒中患者血栓中的占比对预后的影响。方法选取2021年1月—2024年1月东莞市人民医院接诊的102例急性缺血性脑卒中患者为研究对象,均给予机械取栓手术治疗,术后参考改良脑梗死溶栓(mTICI)分级评估血管再通情况分为预后良好组(66例)与预后不良组(36例)。比较两组的围手术期改良Rankin量表(mRS)评分、C反应蛋白(CRP)、中性粒细胞/淋巴细胞、同型半胱氨酸、高纤维蛋白/血小板血栓、高红细胞血栓。采用多因素逐步Logistic回归模型分析急性缺血性脑卒中患者预后不良的影响因素。结果术后24 h、出院前,预后不良组的mRS评分高于预后良好组(P<0.05)。预后不良组患者的CRP水平、中性粒细胞/淋巴细胞比值、同型半胱氨酸水平均高于预后良好组(P<0.05)。预后不良组高纤维蛋白/血小板血栓占比高于预后良好组(P<0.05),高红细胞血栓占比低于预后良好组(P<0.05)。多因素逐步Logistic回归分析结果显示,CRP水平高[OR=3.702(95%CI:1.607,8.529)]、中性粒细胞/淋巴细胞比值高[OR=3.615(95%CI:1.569,8.327)]、同型半胱氨酸水平高[OR=4.076,95%CI:1.769,9.389)]、高纤维蛋白/血小板血栓[OR=3.741(95%CI:1.623,8.615)]均是急性缺血性脑卒中患者预后不良的危险因素(P<0.05)。结论血栓中高纤维蛋白/血小板组分与急性缺血性脑卒中患者的不良预后密切相关。Objective To investigate the proportion of red blood cells(RBCs)and fibrin components in thrombi of acute ischemic stroke(AIS)patients and their impact on prognosis.Methods A total of 102 AIS patients treated with mechanical thrombectomy at Dongguan People's Hospital from January 2021 to January 2024 were enrolled.Based on the modified Thrombolysis in Cerebral Infarction(mTICI)grading for vascular recanalization,patients were divided into a good prognosis group(66 cases)and a poor prognosis group(36 cases).Perioperative modified Rankin Scale(mRS)scores,C-reactive protein(CRP)levels,neutrophil-to-lymphocyte ratio(NLR),homocysteine levels,proportions of high fibrin/platelet thrombi,and high RBC thrombi were compared between the two groups.Multivariate stepwise logistic regression was used to analyze factors associated with poor prognosis in AIS patients.Results At 24 hours postoperatively and before discharge,the mRS scores were significantly higher in the poor prognosis group compared to the good prognosis group(P<0.05).CRP levels,NLR,and homocysteine levels were significantly elevated in the poor prognosis group compared to the good prognosis group(P<0.05).The proportion of high fibrin/platelet thrombi was higher,while the proportion of high RBC thrombi was lower in the poor prognosis group(P<0.05).Multivariate logistic regression analysis indicated that elevated CRP levels[OR=3.702(95%CI:1.607,8.529)],increased NLR[OR=3.615(95%CI:1.569,8.327)],higher homocysteine levels[OR=4.076(95%CI:1.769,9.389)],and a higher proportion of fibrin/platelet thrombi[OR=3.741(95%CI:1.623,8.615)]were independent risk factors for poor prognosis in AIS patients(P<0.05).Conclusion A higher proportion of fibrin/platelet components in thrombi is closely associated with poor prognosis in AIS patients.

关 键 词：急性缺血性脑卒中 血栓成分 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]