凝血因子 XIII 对接受静脉溶栓治疗的缺血性脑卒中患者出血风险的预测价值。

Predictive value of coagulation factor XIII on bleeding risk in ischemic stroke patients treated with intravenous thrombolysis.

机构信息

Department of Clinical Laboratory, Huangzhou District People's Hospital, Huanggang, China.

Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Ann Palliat Med. 2021 Jul;10(7):7579-7586. doi: 10.21037/apm-21-1174.

DOI:10.21037/apm-21-1174

PMID:34353045

Abstract

BACKGROUND

Intravenous thrombolysis (IVT) therapy with recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke (AIS) has a known risk of intracerebral hemorrhage (ICH). We aimed to identify the predictive value of coagulation factor XIII (FXIII) on post-thrombolytic ICH risk in AIS patients.

METHODS

The study cohort included 69 diagnosed AIS patients undergoing IVT treatment within 24 hours of symptom onset. Blood samples taken on admission were analyzed for FXIII antigen levels with an automated latex enhanced immunoassay. Conventional coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (DD) were also tested.

RESULTS

Of the 69 AIS patients, 23 (33.3%) developed post-thrombolytic ICH. Plasma FXIII levels showed a significant decrease, accompanied with elevated FIB and DD levels in AIS patients with post-thrombolytic ICH. Multivariable logistic regression (LR) revealed that FXIII and FIB were independently associated with post-thrombolytic ICH progression. Area under receiver operating characteristic curve of FXIII selected by the further forward logistic regression was 0.823 [95% confidence interval (CI): 0.712-0.904], and the cutoff value of 76.6% yielded good sensitivity at 91.3% and good negative predictive value (NPV) at 93.9%.

CONCLUSIONS

Our findings indicated that plasma FXIII level may be an independent determinant for predicting post-thrombolytic bleeding risk in AIS patients.

摘要

背景

急性缺血性脑卒中（AIS）患者接受重组组织型纤溶酶原激活物（rtPA）静脉溶栓治疗存在已知的颅内出血（ICH）风险。本研究旨在确定凝血因子 XIII（FXIII）对 AIS 患者溶栓后 ICH 风险的预测价值。

方法

研究队列纳入了 69 例在症状发作后 24 小时内接受 IVT 治疗的确诊 AIS 患者。入院时采集的血液样本采用自动化乳胶增强免疫测定法分析 FXIII 抗原水平。同时检测了常规凝血参数，包括凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和 D-二聚体（DD）。

结果

在 69 例 AIS 患者中，有 23 例（33.3%）发生溶栓后 ICH。与溶栓后未发生 ICH 的 AIS 患者相比，溶栓后 ICH 患者的血浆 FXIII 水平显著降低，同时 FIB 和 DD 水平升高。多变量逻辑回归（LR）显示，FXIII 和 FIB 与溶栓后 ICH 进展独立相关。进一步向前的逻辑回归选择的 FXIII 受试者工作特征曲线下面积为 0.823（95%置信区间：0.712-0.904），截断值为 76.6%时具有 91.3%的良好敏感性和 93.9%的良好阴性预测值（NPV）。