摘要
目的比较不同病因急性缺血性脑卒中患者的纤维蛋白原水平,评价纤维蛋白原与大动脉粥样硬化(LAA)型脑卒中的相关性。方法回顾性分析2018年10月至2021年7月于海军军医大学第一附属医院脑血管病中心就诊的急性缺血性脑卒中患者的临床资料及超早期(发病4.5 h内)凝血功能指标。依据急性脑卒中治疗Org 10172试验病因分型明确分型诊断,分析LAA、小动脉闭塞(SAO)、心源性栓塞(CE)患者临床特征和凝血功能指标的差异。采用多因素logistic回归模型分析LAA的独立预测因素。结果共纳入221例急性缺血性脑卒中患者,其中LAA患者58例(26.2%),SAO患者110例(49.8%),CE患者53例(24.0%)。3组患者凝血酶原时间、纤维蛋白原、D-二聚体水平差异均有统计学意义(均P<0.05)。调整混杂因素(年龄、糖尿病、高胆固醇血症、吸烟)后,多因素logistic回归分析显示纤维蛋白原是LAA的独立预测因素(与CE对比OR=3.199,95%CI 1.562~6.553,P=0.001;与SAO对比OR=1.610,95%CI 1.072~2.418,P=0.022)。结论超早期纤维蛋白原水平与LAA型急性缺血性脑卒中相关,或可作为急性缺血性脑卒中超早期病因分型诊断的依据。
Objective To compare the fibrinogen level among patients with acute ischemic stroke of different etiologies and to evaluate the correlation between fibrinogen and large artery atherosclerosis(LAA)stroke.Methods Clinical data and coagulation indexes in ultra-acute phase(within 4.5 h of symptom onset)were retrospectively analyzed in patients with acute ischemic stroke treated at the Neurovascular Center of The First Affiliated Hospital of Naval Medical University from Oct.2018 to Jul.2021.Based on the Trial of Org 10172 in Acute Stroke Treatment,the etiological diagnosis was made.The clinical characteristics and coagulation indexes were compared between LAA,small artery occlusion(SAO)and cardioembolism(CE)groups.Multivariate logistic regression model was used to analyze the independent predictive factors of LAA.Results A total of 221 patients with acute ischemic stroke were enrolled,including 58(26.2%)cases of LAA,110(49.8%)SAO,and 53(24.0%)CE.There were significant differences in prothrombin time,fibrinogen and D-dimer levels among the 3 groups(all P<0.05).Multivariate logistic regression analysis showed that fibrinogen was an independent predictor of LAA when compared with CE(odds ratio[OR]=3.199,95%confidence interval[CI]1.562-6.553,P=0.001)and with SAO(OR=1.610,95%CI 1.072-2.418,P=0.022)after adjusting for confounding factors(age,diabetes mellitus,hypercholesterolemia,and smoking).Conclusion Fibrinogen is associated with acute ischemic stroke due to LAA,and it can be beneficial for etiological diagnosis of acute ischemic stroke in ultra-acute phase.
作者
陈蕾
张敏敏
呼延梅华
黄琪
邓本强
张萍
刘建民
CHEN Lei;ZHANG Minmin;HUYAN Meihua;HUANG Qi;DENG Benqiang;ZHANG Ping;LIU Jianmin(Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Naval Medical Center,Naval Medical University(Second Military Medical University),Shanghai 200052,China)
出处
《海军军医大学学报》
北大核心
2025年第12期1547-1552,共6页
Academic Journal of Naval Medical University
关键词
纤维蛋白原
缺血性脑卒中
病因分型
大动脉粥样硬化
早期诊断
fibrinogen
ischemic stroke
etiological classification
large artery atherosclerosis
early diagnosis
