纤维蛋白原/白蛋白比值预测老年急性缺血性卒中血管内治疗术后预后不良的价值

doi:10.3969/j.issn.1003-9198.2021.03.008

摘要/Abstract

摘要： 目的本研究旨在探索纤维蛋白原/白蛋白比值(fibrinogen to albumin ratio, FAR)对老年急性缺血性卒中病人血管内治疗术后预后不良的预测作用。方法纳入自2015年5月至2018年11月南京市第一医院神经内科收治的接受血管内治疗的老年急性前循环大血管闭塞性缺血性卒中病人,回顾性分析其临床资料以及预后情况,比较转归良好组与转归不良组基线资料。采用多元Logistic回归分析血管内治疗术后90 d预后不良的独立危险因素,并使用ROC曲线分析FAR水平对血管内治疗后90 d转归不良的预测价值。结果转归不良组的年龄(P=0.001)、卒中史(P=0.003)、基线NIHSS评分(P=0.001)、ASITN/SIR侧支循环分级 0~2级比例(P=0.019)、症状性颅内出血(sICH)构成比(P=0.037)、FPG水平(P=0.001)、FAR水平(P=0.001)均显著高于转归良好组,Hcy水平(P=0.034)显著低于转归良好组。多因素Logistic回归校正年龄、卒中史、基线NIHSS评分、侧支循环分级 0~2级比例、sICH、FPG水平、Hcy水平等混杂因素后显示,FAR是血管内治疗术后90 d转归不良的独立危险因素(OR=25.048,95%CI:8.938~44.733,P＝0.001)。FAR预测血管内治疗术后90 d转归不良的AUC为0.711,最佳截断值为0.0868,此时的敏感度和特异度分别为60.72%和77.88%。结论 FAR增高可用于预测老年急性缺血性卒中病人血管内治疗术后90 d转归不良。

关键词: 脑梗死, 血管内治疗, 预后, 纤维蛋白原/白蛋白比值, 危险因素, 老年人

Abstract: Objective To investigate the predicting value of the ratio of fibrinogen to albumin (FAR) for the adverse prognosis in the elderly patients with acute ischemic stroke receiving endovascular treatment. Methods The clinical data of the elderly patients who received endovascular treatment of anterior circulation in Nanjing First Hospital were collected, prospectively, from May 2015 to November 2018. The outcome of the patients was evaluated 90 days after treatment, and they were divided into good prognosis group and poor prognosis group. The baseline data were compared between the two groups. The influencing factors of prognosis were investigated by the multivariate Logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of FAR to the poor prognosis after 90 days. Results The age, history of stroke, baseline NIHSS score, ASITN/SIR collateral circulation grade 0-2, symptomatic intracranial hemorrhage, fasting blood glucose and FAR in the poor prognosis group were significantly higher than those in the good prognosis group, and the level of homocysteine in the poor prognosis group was lower (P<0. 05). Multivariate Logistic regression showed that FAR (OR=25. 048, 95%CI:8. 938-44. 733) was an independent predictor of poor prognosis after 90 days, after adjusting for the confounding factors including age, history of stroke, baseline NIHSS score, ASITN/SIR collateral circulation grade 0-2, symptomatic intracranial hemorrhage, fasting blood glucose and homocysteine. The area under the ROC curve of the FAR for predicting poor prognosis after 90 days was 0. 711 (95% CI: 0. 645-0. 772, P<0. 001). The sensitivity and specificity of predicting the poor prognosis were 60. 23% and 84. 17%, and the optimal cut-off value of FAR was 0. 0868. Conclusions The increasing FAR level may be able to predict poor outcome at 90 days in the elderly patients with acute ischemic stroke undergoing the endovascular treatment of anterior circulation.

Key words: brain ischemia, endovascular treatment, prognosis, fibrinogen to albumin ratio, risk factors, aged

中图分类号:

R 743.33

张中华, 黄清, 刘春梅, 史宝柱. 纤维蛋白原/白蛋白比值预测老年急性缺血性卒中血管内治疗术后预后不良的价值[J]. 实用老年医学, 2021, 35(3): 241-245.

ZHANG Zhong-hua, HUANG Qing, LIU Chun-mei, SHI Bao-zhu. Correlation between fibrinogen to albumin ratio and poor prognosis 90 days after endovascular treatment in elderly patients with acute ischemic stroke[J]. Practical Geriatrics, 2021, 35(3): 241-245.

参考文献

[1] ZHOU M, WANG H, ZENG X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204):1145-1158.
[2] 刘春梅,施洪超,黄清,等.机械血栓切除术治疗心房颤动所致心源性栓塞性卒中的有效性和安全性:与单纯静脉溶栓的比较[J]. 国际脑血管病杂志,2018,26(3):161-166.
[3] ALBERS G W, MARKS M P, KEMP S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med,2018,378(8):708-718.
[4] NOGUEIRA R G, JADHAV A P, HAUSSEN D C, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med, 2018, 378(1):11-21.
[5] BERKHEMER O A, FRANSEN P S, BEUMER D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015, 372(1):11-20.
[6] SAVER J L, GOYAL M, BONAFE A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in strok[J]. N Engl J Med, 2015, 372(24): 2285-2295.
[7] LI D, XING C, LI Y, ZHU X. Elevated plasma fibrinogen indicates short-term poor outcome in patients with acute ischemic stroke after intravenous thrombolysis[J]. J Stroke Cerebrovasc Dis, 2020, 29(8):104991.
[8] LEE S J, HONG J M, LEE S E, et al. Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes[J]. BMC Neurol,2017,17(1):101.
[9] WANG C, DENG L, QIU S, et al. Serum albumin is negatively associated with hemorrhagic transformation in acute ischemic stroke patients[J]. Cerebrovasc Dis,2019,47(1/2):88-94.
[10] ACHARYA P, JAKOBLEFF W A, FOREST S J, et al. Fibrinogen albumin ratio and ischemic stroke during venoarterial extracorporeal membrane oxygenation[J]. ASAIO J,2020,66(3):277-282.
[11] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[12] SHETH S A, SANOSSIAN N, HAO Q, et al. Collateral flow as causative of good outcomes in endovascular stroke therapy[J]. J Neurointerv Surg, 2016, 8(1):2-7.
[13] HERRICK S, BLANC-BRUDE O, GRAY A, et al. Fibrinogen[J]. Int J Biochem Cell Biol, 1999, 31(7): 741-746.
[14] TOUSOULIS D, PAPAGEORGIOU N, ANDROULAKIS E, et al. Fibrinogen and cardiovascular disease: genetics and biomarkers[J]. Blood Rev, 2011, 25(6): 239-245.
[15] SCHNEIDER D J, TAATJES D J, HOWARD D B, et al. Increased reactivity of platelets induced by fibrinogen independent of its binding to the IIb-IIIa surface glycoprotein: a potential contributor to cardiovascular risk[J]. J Am Coll Cardiol,1999,33(1):261-266.
[16] IDICULA T T, WAJE-ANDREASSEN U, BROGGER J, et al. Serum albumin in ischemic stroke patients: the higher the better. The Bergen Stroke Study[J]. Cerebrovasc Dis, 2009,28(1):13-17.
[17] DZIEDZIC T, PERA J, KLIMKOWICZ A, et al. Serum albumin level and nosocomial pneumonia in stroke patients[J]. Eur J Neurol,2006,13(3):299-301.
[18] 王蒙, 黄婷, 刘宇恺, 等.时间窗与组织窗管理对老年急性脑梗死静脉溶栓预后的影响[J]. 实用老年医学,2020,34(8):797-801.
[19] 侯延伟, 郭再玉, 吐尔洪·吐尔逊, 等. 急性缺血性卒中患者血管内机械血栓切除术后出血性转化的预测因素 [J]. 国际脑血管病杂志, 2019, 27(1): 1-5.
[20] ZHANG X, YUAN K, WANG H, et al. Nomogram to predict mortality of endovascular thrombectomy for ischemic stroke despite successful recanalization[J]. J Am Heart Assoc,2020,9(3):e014899.