Lee Seong-Joon, Hong Ji Man, Lee Sung Eun, Kang Dae Ryong, Ovbiagele Bruce, Demchuk Andrew M, Lee Jin Soo
Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do, 443-721, South Korea.
Center of Biomedical Data Science/ Institute of Genomic Cohort, Yonsei University Wonju College of Medicine, Wonju, South Korea.
BMC Neurol. 2017 May 19;17(1):101. doi: 10.1186/s12883-017-0865-7.
Diabetes mellitus (DM) is a risk factor for early neurological deterioration (END) in acute ischemic stroke. The prothrombotic protein fibrinogen is frequently elevated in patients with diabetes, and may be associated with poorer prognoses. We evaluated whether fibrinogen is associated with END in patients with diabetes after acute ischemic stroke.
We included 3814 patients from a single hospital database admitted within 72 h of onset of ischemic stroke. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥2 within 7 days post-admission. In the total population (END, n = 661; non-END, n = 3153), univariate and multivariate analyses were performed to assess fibrinogen as an independent predictor for END. We then performed propensity score matching and univariate analyses for DM (END, n = 261; non-END, n = 522) and non-DM populations (END, n = 399; non-END, n = 798). Multiple logistic analyses were performed after matching for fibrinogen as a risk factor in each subgroup.
Fibrinogen levels were higher in the END group than in the non-END group (367 ± 156 mg/dL vs. 347 ± 122 mg/dL, p = 0.002), though they were not associated with END in logistic regression analyses. Fibrinogen levels were found to be an independent predictor for END, but only in the DM population (fibrinogen levels 300-599 mg/dL, odds ratio: 1.618, 95% confidence interval: 1.037-2.525, p = 0.034, fibrinogen levels ≥600 mg/dL, 2.575, 1.018-6.514, p = 0.046; non-DM population, p = 0.393). The diabetes-fibrinogen interaction for the entire cohort was p = 0.101.
Elevated fibrinogen is dose-dependently associated with END in patients with diabetes following acute ischemic stroke.
糖尿病（DM）是急性缺血性卒中早期神经功能恶化（END）的一个危险因素。促血栓形成蛋白纤维蛋白原在糖尿病患者中常常升高，且可能与较差的预后相关。我们评估了纤维蛋白原是否与急性缺血性卒中后糖尿病患者的END相关。
我们纳入了来自一家单一医院数据库的3814例在缺血性卒中发病72小时内入院的患者。END定义为入院后7天内美国国立卫生研究院卒中量表（NIHSS）评分增加≥2分。在总体人群中（END组，n = 661；非END组，n = 3153），进行单因素和多因素分析以评估纤维蛋白原作为END的独立预测因子。然后我们对糖尿病患者（END组，n = 261；非END组，n = 522）和非糖尿病患者人群（END组，n = 399；非END组，n = 798）进行倾向评分匹配和单因素分析。在匹配后对每个亚组中作为危险因素的纤维蛋白原进行多因素逻辑分析。
END组的纤维蛋白原水平高于非END组（367±156mg/dL对347±122mg/dL，p = 0.002），尽管在逻辑回归分析中它们与END无关。纤维蛋白原水平被发现是END的一个独立预测因子，但仅在糖尿病患者人群中（纤维蛋白原水平300 - 599mg/dL，比值比：1.618，95%置信区间：1.037 - 2.525，p = 0.034；纤维蛋白原水平≥600mg/dL，2.575，1.018 - 6.514，p = 0.046；非糖尿病患者人群，p = 0.393）。整个队列的糖尿病 - 纤维蛋白原相互作用p = 0.101。
急性缺血性卒中后糖尿病患者中，纤维蛋白原升高与END呈剂量依赖性相关。
