血清纤维蛋白原、D-二聚体联合血栓弹力图对静脉溶栓后急性缺血性脑卒中患者预后的预测价值

Predictive value of serum fibrinogen, D-dimer combined with thromboelastography on the prognosis of acute ischemic stroke patients after intravenous thrombolysis

摘要:

目的 探讨血清纤维蛋白原（FIB）、D-二聚体（D-dimer）及血栓弹力图（TEG）预测静脉溶栓后急性缺血性脑卒中患者预后的价值。方法 选取2021年3月—2022年3月巴中市中心医院收治的96例急性缺血性脑卒中患者，按照3个月后的预后情况分为预后良好组72例和预后不良组24例。比较两组患者的人口学和临床资料，影响因素的分析采用多因素逐步Logistic回归模型，构建受试者工作特征（ROC）曲线评估血清FIB、D-dimer及TEG参数对急性缺血性脑卒中患者预后的预测价值。结果 预后良好组高血压患病率、凝血酶原时间、FIB、D-dimer、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平、反应时间（R值）和凝固时间（K值）均低于预后不良组（P <0.05），α角、最大振幅（MA值）和30 min后的振幅百分比（LY30）均高于预后不良组（P <0.05）。多因素逐步Logistic回归分析结果显示：FIB水平［O^R =0.351（95% CI：0.184，0.670）］、D-dimer水平［O^R =0.010（95% CI：0.001，0.125）］、R值［O^R =0.305（95% CI：0.161，0.579）］和K值［O^R =0.020（95% CI：0.004，0.101）］均为缺血性脑卒中患者预后不良的保护因素（P <0.05）；α角［O^R =1.088（95% CI：1.037，1.141）］、MA值［O^R =1.093（95% CI：1.037，1.152）］为缺血性脑卒中患者预后不良的危险因素（P <0.05）。FIB、D-dimer联合R值、K值、α角、MA值预测急性缺血性脑卒中患者预后不良的曲线下面积为0.935（95% CI：0.880，0.990），敏感性为87.5%（95% CI：0.676，0.973），特异性为93.1%（95% CI：0.845，0.977），优于单独预测。结论 血清FIB、D-dimer联合TEG参数在预测静脉溶栓后急性缺血性脑卒中患者的预后方面展现出显著的价值。

Abstract:

Objective To investigate the predictive value of serum fibrinogen (FIB), D-dimer, and thromboelastography (TEG) for the prognosis of acute ischemic stroke (AIS) patients after intravenous thrombolysis.Methods A total of 96 AIS patients admitted to Bazhong Central Hospital from March 2021 to March 2022 were selected and divided into a favorable prognosis group (n = 72) and an unfavorable prognosis group (n = 24) based on their outcomes at 3 months. Demographic and clinical data were compared between the two groups using univariate analysis, and statistically significant factors were subjected to logistic regression analysis. ROC curves were constructed to assess the predictive value of serum FIB, D-dimer, and TEG parameters for AIS prognosis.Results The prevalence of hypertension, as well as levels of PT, FIB, D-dimer, total cholesterol, LDL-C, HDL-C, R value, and K value, were all significantly lower in the favorable prognosis group compared to the poor prognosis group (P <0.05). Conversely, α angle, MA value, and LY30 were significantly higher in the favorable prognosis group (P <0.05). Multivariate stepwise logistic regression analysis revealed that FIB levels [O^R = 0.351 (95% CI: 0.184, 0.670)], D-dimer levels [O^R = 0.010 (95% CI: 0.001, 0.125) ], R value [O^R = 0.305 (95% CI: 0.161, 0.579) ], and K value [O^R = 0.020 (95% CI: 0.004, 0.101) ] were protective factors for poor prognosis in patients with ischemic stroke (P < 0.05). In contrast, α angle [O^R = 1.088 (95% CI: 1.037, 1.141) ] and MA value [O^R = 1.093 (95% CI: 1.037, 1.152) ] were identified as risk factors for poor prognosis (P < 0.05). The combined prediction model using FIB, D-dimer, R value, K value, α angle, and MA value yielded the area under the curve of 0.935 (95% CI: 0.880, 0.990), with a sensitivity of 87.5% (95% CI: 0.676, 0.973) and a specificity of 93.1% (95% CI: 0.845, 0.977), outperforming individual predictive indicators.Conclusion The combination of serum FIB, D-dimer, and TEG parameters provides significant value in predicting the prognosis of AIS patients after intravenous thrombolysis.