Rallidis L S, Vikelis M, Panagiotakos D B, Liakos G K, Krania E, Kremastinos D T
Second Department of Cardiology, University General Hospital Attikon, Athens.
Acta Neurol Scand. 2008 Jun;117(6):415-20. doi: 10.1111/j.1600-0404.2007.00971.x. Epub 2007 Dec 18.
There is increasing evidence that inflammation and hypercoagulability play an important role in the pathophysiology of acute ischaemic stroke. We examined the in-hospital prognostic value on mortality of C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-alpha), fibrinogen and D-dimer in middle-aged ischaemic stroke patients.
We recruited 231 consecutive patients <66 years with acute ischaemic stroke. CRP, TNF-alpha, fibrinogen and D-dimer levels were determined within 12 h from admission.
Fifteen (6.5%) patients died during hospitalization. CRP, fibrinogen and D-dimer levels were significantly higher in patients who died compared with those who survived but only CRP and fibrinogen were independently associated with death, after adjusting for various confounding factors. For 1 mg/l increase in CRP there was a 20% higher risk of dying while for 10 mg/dl increase in fibrinogen the additive risk was 18%. CRP levels >18 mg/l and fibrinogen levels >490 mg/dl were the optimal points that discriminated those who died from the rest.
CRP and fibrinogen levels can predict independently the risk of early death in middle-aged ischaemic stroke patients emphasizing the role of inflammation and coagulation in the evolution of ischaemic stroke.
越来越多的证据表明，炎症和高凝状态在急性缺血性中风的病理生理过程中起重要作用。我们研究了C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、纤维蛋白原和D-二聚体对中年缺血性中风患者院内死亡率的预后价值。
我们连续招募了231例年龄<66岁的急性缺血性中风患者。入院后12小时内测定CRP、TNF-α、纤维蛋白原和D-二聚体水平。
15例（6.5%）患者在住院期间死亡。与存活患者相比，死亡患者的CRP、纤维蛋白原和D-二聚体水平显著升高，但在调整各种混杂因素后，只有CRP和纤维蛋白原与死亡独立相关。CRP每升高1mg/l，死亡风险增加20%，而纤维蛋白原每升高10mg/dl，附加风险为18%。CRP水平>18mg/l和纤维蛋白原水平>490mg/dl是区分死亡患者与其他患者的最佳切点。
CRP和纤维蛋白原水平可独立预测中年缺血性中风患者的早期死亡风险，强调了炎症和凝血在缺血性中风发展过程中的作用。
