天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (12): 1282-1286.doi: 10.11958/20211514

• 临床研究 • 上一篇    下一篇

纤维蛋白原/白蛋白比值与急性缺血性卒中患者rt-PA静脉溶栓后早期神经功能恶化的关系

古春青，张运克，杨广华，武继涛   

  1. 河南中医药大学第一附属医院脑病科（邮编450000）
  • 收稿日期:2021-06-28 修回日期:2021-08-10 出版日期:2021-12-15 发布日期:2021-12-27
  • 通讯作者: △通信作者 E-mail：henanzyk@126.com E-mail:△通信作者 E-mail：henanzyk@126.com
  • 作者简介:古春青（1972），女，硕士，副主任医师，主要从事中医脑病诊治及研究工作。E-mail：gcqhappy72@163.com
  • 基金资助:
    国家自然科学基金资助项目（81974564）

The relationship between fibrinogen to albumin ratio and early neurological deterioration after rt-PA intravenous thrombolysis in patients with acute ischemic stroke

GU Chun-qing, ZHANG Yun-ke△, YANG Guang-hua, WU Ji-tao   

  1. Department of Encephalopathy, the First Affiliated Hospital of Henan University of Chinese Medicine,
    Zhengzhou 450000, China
    △Corresponding Author E-mail: henanzyk@126.com
  • Received:2021-06-28 Revised:2021-08-10 Published:2021-12-15 Online:2021-12-27
  • Contact: △Corresponding Author E-mail: henanzyk@126.com E-mail:△通信作者 E-mail：henanzyk@126.com

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摘要： 目的 探讨纤维蛋白原/白蛋白比值（FAR）与急性缺血性卒中（IS）患者重组组织型纤溶酶原激活剂（rtPA）静脉溶栓后早期神经功能恶化（END）的关系。方法 纳入接受rt-PA静脉溶栓治疗的IS患者156例，根据是否 出现END将其分为END组36例和非END组120例。收集患者基线资料，采用Pearson相关分析急性IS患者FAR与 溶栓前美国国立卫生研究院卒中量表（NIHSS）评分的相关性，受试者工作特征（ROC）曲线分析相关指标预测急性IS 患者rt-PA静脉溶栓后END的价值，多因素Logistic回归分析影响急性IS患者rt-PA静脉溶栓后END的危险因素。 结果 IS患者rt-PA静脉溶栓后END发生率为23.08%。END组患者溶栓前NIHSS评分、血糖、白细胞计数、血清纤 维蛋白原（FIB）水平及FAR均明显高于非END组患者，血清白蛋白（ALB）水平明显低于非END组（P＜0.05）。IS患 者 FAR 与溶栓前 NIHSS 评分呈正相关（P＜0.05）。FAR 预测 IS 患者 rt-PA 静脉溶栓后 END 的曲线下面积为 0.806 （0.710~0.902），高于ALB［0.609（0.494~0.724）］和FIB［0.639（0.524~0.754）］，但低于溶栓前NIHSS评分［0.963（0.931~ 0.994），P＜0.05］。FAR和溶栓前NIHSS评分升高是影响IS患者rt-PA静脉溶栓后END的独立危险因素（P＜0.05）。 结论 FAR升高与IS患者rt-PA静脉溶栓后END有关，可预测IS患者rt-PA静脉溶栓后END的发生。

关键词: 卒中, 脑缺血, 组织型纤溶酶原激活物, 纤维蛋白原, 血清白蛋白, 血栓溶解疗法, 早期神经功能恶化

Abstract: Objective To explore the relationship between fibrinogen to albumin ratio (FAR) and the early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in patients with acute ischemic stroke (IS). Methods A total of 156 patients with IS who received rt-PA intravenous thrombolysis were included. According to the occurrence of END, patients were divided into the END group (n=36) and the non-END group (n= 120). The baseline data were collected. Pearson test was used to analyze the correlation between the FAR of IS patients and the National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis. The receiver operating characteristic (ROC) curve was used to analyze the value of relevant indicators to predict END after rt-PA intravenous thrombolysis in IS patients. Multivariate Logistic regression analysis was used to analyze the risk factors of END after rt-PA intravenous thrombolysis in IS patients. Results The incidence of END after rt-PA intravenous thrombolysis was 23.08% in patients with acute IS. The NIHSS score, blood sugar, white blood cell count, serum fibrinogen (FIB) level and FAR were significantly higher before thrombolysis in the END group than those of the non-END group, and the serum albumin (ALB) level was significantly lower in the END group than that of non-END group (P＜0.05). The FAR of IS patients was positively correlated with NIHSS score before thrombolysis (P＜0.05). The area under curve of FAR predicting END after rt-PA intravenous thrombolysis in IS patients was 0.806 (0.710-0.902), which was significantly higher than that of ALB［0.609(0.494-0.724)］and FIB［0.639 (0.524-0.754)］; but it was lower than the AUC of NIHSS score［0.963(0.931-0.994)］before thrombolysis (P＜0.05). The increased FAR and NIHSS score before thrombolysis were independent risk factors for END after rt-PA intravenous thrombolysis in IS patients (P＜0.05). Conclusion The increase of FAR is related to END after rt-PA intravenous thrombolysis, which can be used as a basis for predicting the occurrence of END after rt-PA intravenous thrombolysis in IS patients.

Key words: stroke, brain ischemia, tissue plasminogen activator, fibrinogen, serum albumin, thrombolytic therapy,
early neurological deterioration

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