Liang O V, Kochetov A G, Shamalov N A, Anisimov K V, Ramazanov G R, Arkhipkin A A, Novozhenova Iu V, Kustova M A, Podshivalov D C, Egorov V O
Ter Arkh. 2012;84(10):42-7.
To identify and investigate threshold fibrinogen concentrations as predictors of hemorrhagic transformation (HT), fatal outcome (FO), and the efficiency of thrombolytic therapy (TLT) in patients with ischemic stroke (IS).
One hundred and eighty-one patients with IS were examined; all the patients received TLT. Fibrinogen concentrations were determined by the Clauss method on admission, immediately after TLT, and daily during the first 7 days of observation; the efficacy of thrombolysis was evaluated using the NIH stroke scale every day, the Rankin scale, and the Barthel Index on days 14 and 21.
The patients with a fibrinogen concentration of below 330 mg/dl showed the lowest frequency of asymptomatic HT (AHT) as hemorrhagic stroke (HS) type 1 in the absence of clinically worsening HT (CWHT), as well as FO and the highest rate of good functional recovery. Those with a fibrinogen concentration of 330-385 mg/dl most commonly displayed AHT as HS types 1 and 2 equally frequently, as well as the highest frequency of a positive effect according to the criteria for good and/or satisfactory functional recoveries. The fibrinogen concentration range of 385-423 mg/dl compared to the above range was characterized by an increased risk for AHT as HS type 2, for CWHT as equally distributed parenchymal hematoma types 1 and 2, by higher death rates and less chance of functional recovery. The elevated fibrinogen concentration above 423 mg/dl was accompanied by high death rates and CWHT as parenchymal hematoma type 2 and the higher frequency of poor outcome in the evaluation of functional recovery.
The revealed three threshold fibrinogen concentrations of 330, 385, and 423 mg/dl allow one to predict HS, FO, and the efficiency of TLT in patients with IS.
确定并研究纤维蛋白原浓度阈值作为缺血性卒中（IS）患者出血性转化（HT）、致命结局（FO）及溶栓治疗（TLT）疗效的预测指标。
对181例IS患者进行检查；所有患者均接受TLT。采用Clauss法在入院时、TLT后即刻以及观察的前7天每天测定纤维蛋白原浓度；每天使用美国国立卫生研究院卒中量表评估溶栓疗效，在第14天和第21天使用Rankin量表和Barthel指数进行评估。
纤维蛋白原浓度低于330mg/dl的患者，无症状HT（AHT）作为1型出血性卒中（HS）且无临床症状恶化性HT（CWHT）的发生率最低，FO发生率也最低，功能恢复良好率最高。纤维蛋白原浓度为330 - 385mg/dl的患者，AHT最常见为1型和2型HS，且根据良好和/或满意功能恢复标准，积极效果的发生率最高。与上述范围相比，纤维蛋白原浓度范围为385 - 423mg/dl的患者，2型HS的AHT风险增加，1型和2型实质内血肿导致的CWHT发生率相同，死亡率更高，功能恢复机会更少。纤维蛋白原浓度高于423mg/dl时，死亡率高，2型实质内血肿导致CWHT，功能恢复评估中不良结局的发生率更高。
所揭示的330、385和423mg/dl这三个纤维蛋白原浓度阈值可用于预测IS患者的HS、FO及TLT疗效。
