Xu Yaying, Qu Xiaofeng, Ren Taojie, Wang Liling, Gao Yang
The Yancheng Clinical College of Xuzhou Medical University, No 166 Yulong Road, Yancheng, Jiangsu 224000, China; Department of Neurology, Yancheng City No.1 People's Hospital, No 166 Yulong Road, Yancheng, Jiangsu 224000, China.
Department of Neurology, Yancheng City No.1 People's Hospital, No 166 Yulong Road, Yancheng, Jiangsu 224000, China.
J Clin Neurosci. 2023 May;111:6-10. doi: 10.1016/j.jocn.2023.02.019. Epub 2023 Mar 8.
We aimed to investigate the correlation between fibrinogen levels and functional outcomes at 90 days after intravenous thrombolysis therapy (IVT) in patients with acute ischaemic stroke (AIS).
We identified patients with AIS who received IVT (alteplase 0.6 or 0.9 mg/kg) between 1 January 2019 and 31 March 2022 in Yancheng 1st People's Hospital. Fibrinogen levels were measured before IVT, and the 90-day post-stroke functional outcome was evaluated using the modified Rankin Scale (mRS). An mRS score of 0-2 indicated functional independence, whereas an mRS score of 3-6 indicated functional dependence. Potential outcome predictors were evaluated using univariate and multivariate analyses, and receiver operating characteristic (ROC) curve analysis was performed to assess the performance of fibrinogen levels in predicting the 90-day outcome.
A total of 276 patients with AIS who received IVT within 4.5 h of stroke onset were enrolled, of whom 165 and 111 were categorised into the functional independence and functional dependence groups, respectively. Univariate analysis showed that the fibrinogen, homocysteine, high-density lipoprotein cholesterol, and D-dimer levels; age; National Institutes of Health Stroke Scale (NIHSS) score on admission; NIHSS score 24 h after IVT; and incidence of cardioembolism were higher in the functional dependence group than in the functional independence group (P < 0.05). Meanwhile, the thrombin time and the incidence of small-vessel occlusion in the functional dependence group were smaller than those in the functional independence group (P < 0.05). Multivariate logistic regression analysis showed that fibrinogen and homocysteine levels were both independent risk factors for 90-day functional dependence in patients with AIS (odds ratio [OR] 2.822, 95% confidence interval [95% CI]: 1.214-6.558, P = 0.016 for fibrinogen; OR 1.048, 95 %CI: 1.002-1.096, P = 0.041 for homocysteine). The area under the ROC curve of fibrinogen levels before IVT for predicting poor functional outcomes was 0.664, with a sensitivity, specificity, positive predictive value, and negative predictive value of 40.9%, 80.8%, 68.9%, and 64.3%, respectively.
In patients with AIS, fibrinogen levels have a certain predictive value for short-term functional outcomes after IVT.
我们旨在研究急性缺血性卒中（AIS）患者静脉溶栓治疗（IVT）后90天纤维蛋白原水平与功能结局之间的相关性。
我们确定了2019年1月1日至2022年3月31日期间在盐城市第一人民医院接受IVT（阿替普酶0.6或0.9mg/kg）的AIS患者。在IVT前测量纤维蛋白原水平，并使用改良Rankin量表（mRS）评估卒中后90天的功能结局。mRS评分为0-2表示功能独立，而mRS评分为3-6表示功能依赖。使用单因素和多因素分析评估潜在的结局预测因素，并进行受试者工作特征（ROC）曲线分析以评估纤维蛋白原水平在预测90天结局方面的性能。
总共纳入了276例在卒中发作4.5小时内接受IVT的AIS患者，其中165例和111例分别被归类为功能独立组和功能依赖组。单因素分析显示，功能依赖组的纤维蛋白原、同型半胱氨酸、高密度脂蛋白胆固醇和D-二聚体水平；年龄；入院时美国国立卫生研究院卒中量表（NIHSS）评分；IVT后24小时的NIHSS评分；以及心源性栓塞的发生率均高于功能独立组（P<0.05）。同时，功能依赖组的凝血酶时间和小血管闭塞的发生率低于功能独立组（P<0.05）。多因素逻辑回归分析显示，纤维蛋白原和同型半胱氨酸水平均是AIS患者90天功能依赖的独立危险因素（纤维蛋白原的优势比[OR]为2.822，95%置信区间[95%CI]：1.214-6.558，P=0.016；同型半胱氨酸的OR为1.048，95%CI：1.002-1.096，P=0.041）。IVT前纤维蛋白原水平预测功能结局不良的ROC曲线下面积为0.664，敏感性、特异性、阳性预测值和阴性预测值分别为40.9%、80.8%、68.9%和64.3%。
在AIS患者中，纤维蛋白原水平对IVT后的短期功能结局具有一定的预测价值。
