摘要
目的 探讨急性缺血性脑卒中(AIS)患者血栓四项、凝血指标与患者神经功能损伤严重程度及短期预后的相关性.方法 将2022年6月至2024年6月溧阳市人民医院收治的100例AIS患者纳入本次回顾性研究,依据入院时美国国立卫生研究院卒中量表(NIHSS)评分分成轻度组(n=28)、中度组(n=50)和重度组(n=22);根据出院后90 d mRS评分将患者分为预后良好组(n=72)和预后不良组(n=28).比较不同神经功能损伤程度患者、不同预后患者的血栓四项[凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)、组织纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(tPAI-C)]和凝血指标[活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、D-二聚体、纤维蛋白原(FIB)];用Spearman相关性分析血栓四项、凝血指标与NIHSS评分的相关性;并采用多因素Logistic回归分析法分析影响AIS患者的短期预后的因素.结果 3组的APTT、PT比较,差异均无统计学意义(P＞0.05);3组的D-二聚体和FIB比较,差异均有统计学意义(P＜0.05),重度组的D-二聚体、FIB分别为(1.50±0.17)mg/L、(3.57±0.61)g/L,均显著高于中度组[(1.17±0.25)mg/L、(3.10±0.72)g/L]、轻度组[(0.69±0.12)mg/L、(2.75±0.56)g/L],中度组的D-二聚体、FIB均显著高于轻度组,差异均有统计学意义(P＜0.05).3组的TM、TAT、PIC和t-PAIC比较,差异均有统计学意义(P＜0.05),重度组的TM、TAT、PIC和t-PAIC分别为(23.76±3.40)IU/mL、(42.80±4.33)ng/mL、(1.90±0.32)mg/L、(34.78±3.50)μg/L,均显著高于中度组[(17.50±3.27)IU/mL、(35.55±4.62)ng/mL、(1.58±0.24)mg/L、(25.51±4.12)μg/L]和轻度组[(12.61±2.34)IU/mL、(26.39±3.77)ng/mL、(1.15±0.13)mg/L、(18.44±3.13)μg/L],中度组的 TM、TAT、PIC 和 t-PAIC 均显著高于轻度组,差异均有统计学意义(P＜0.05).Spearman相关性分析显示,血浆D-二聚体、FIB、TM、TAT、PIC、t-PAIC与AIS患者的NIHSS评分均呈正相关(r=0.798、0.630、0.695、0.753、0.673、0.720,P＜0.05).相比于预后良好组,预后不良组的D-二聚体、FIB和血栓四项均显著升高,差异均有统计学意义(P＜0.05).Logistic回归分析显示,D-二聚体、FIB、血栓四项均为影响AIS短期预后的独立危险因素(P＜0.05).结论 D-二聚体、FIB、血栓四项与AIS患者病情严重程度密切相关,也是AIS患者短期预后不良的危险因素.
Abstract
Objective To explore the correlation between four thrombosis factors and coagulation indicators with the severity of neurologi-cal damage and short-term prognosis in patients with acute ischemic stroke(AIS).Methods A total of 100 patients with AIS admitted to Liyang People's Hospital from May 2022 to May 2024 were included in this retrospective study and were divided into the mild group(n=28),the moder-ate group(n=50),and the severe group(n=22)based on the National Institute of Health stroke scale(NIHSS)score at admission.Patients were divided into the good prognosis group(n=72)and the poor prognosis group(n=28)based on the 90 d mRS score.The four thrombotic parameters[including thrombin-antithrombin complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM),tissue plasminogen activator/plasminogen activator inhibitor-1 complex(tPAI-C)]and coagulation function indicators[activated partial thromboplas-tin time(APTT),prothrombin time(PT),D-dimer,fibrinogen(FIB)]were compared.Spearman correlation analysis was used to investigate the correlation between four thrombotic parameters,coagulation function indicators,and NIHSS.The factors affecting the short-term prognosis of AIS patients were analyzed by multivariate logistic regression analysis.Results There was no statistically significant difference in APTT and PT a-mong the three groups(P＞0.05);there were statistically significant differences in D-dimer and FIB among the three groups(P＜0.05);the D-dimer and FIB in the severe group were(1.50±0.17)mg/L,(3.57±0.61)g/L,which were significantly higher than those in the moder-ate group[(1.17±0.25)mg/L,(3.10±0.72)g/L]and the mild group[(0.69±0.12)mg/L,(2.75±0.56)g/L],and the D-dimer and FIB in the moderate group were significantly higher than those in the mild group,with statistically significant differences(P＜0.05).There were statistically significant differences in TM,TAT,PIC and t-PAIC among the three groups(P＜0.05).The TM,TAT,PIC and t-PAIC in the severe group were(23.76±3.40)IU/mL,(42.80±4.33)ng/mL,(1.90±0.32)mg/L and(34.78±3.50)μg/L,respectively,which were significantly higher than those in the moderate group[(17.50±3.27)IU/mL,(35.55±4.62)ng/mL,(1.58±0.24)mg/L,(25.51±4.12)µg/L]and the mild group[(12.61±2.34)IU/mL,(26.39±3.77)ng/mL,(1.15±0.13)mg/L,(18.44±3.13)µg/L],TM,TAT,PIC and t-PAIC in the moderate group were significantly higher than those in the mild group,and the differences were statistically signifi-cant(P＜0.05).Spearman correlation analysis showed that D-D,FIB,TM,TAT,PIC,t-PAIC were positively correlated with NIHSS scores in AIS patients(r=0.798,0.630,0.695,0.753,0.673,0.720;P＜0.05).D-D,FIB,and four thrombosis factors within the poor prog-nosis group were markedly greater increased compared to the good prognosis group(P＜0.05).Logistic regression analysis showed that D-D,FIB and four thrombosis factors were risk factors for poor prognosis in AIS patients.Conclusion D-D,FIB,and four thrombosis factors are closely related to the severity of AIS patients and are also risk factors for poor short-term prognosis in AIS patients.
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