血浆纤维蛋白原检测在短暂性脑缺血发作预后判断中的应用

摘要

Objective To explore the predictive value of the level of plasma fibrinogen ( FIB ) for the prognosis of pa-tients with transient ischemic attack ( TIA) .Methods 132 patients with acute TIA in hospitalization were enrolled .These patients were divided into low (0~3 points, 46 patients), mederate (4~5 points, 70 patients) and high (6~7 points, 16 patients) risk groups according to their ABCD2 scores.The levels of FIB were detected by using SYSTEX CA-7000 Au-tomated Blood Coagulation Analyzer .The primary outcome measure was a composite endpoint consisting of stroke or death within 90 days;≥50%stenosis in a artery association with clinical symptoms or cardioembolic source warranting anticoagu -lation.Results The composite end point occurred in 34 patients ( positive group ) and was not found in other 98 patients ( negative group ).The level of FIB was higher in positive group compared to negative group [(4.53 ±0.99) vs (3.05 ± 0.93)g/L, P<0.05].There was significant difference among low-risk, mederate-risk and high-risk groups in the levels of plasma FIB [(2.98 ±0.86) vs (3.54 ±1.47) vs (5.16 ±1.68)g/L, P<0.05].Spearman rank correlation coefficient test showed that the level of plasma FIB was positively correlated with ABCD 2 score (r=0.388, P<0.001).Cox regres-sion analysis showed that ABCD 2 score ≥4 and FIB≥3.5 g/L were significantly associated with the composite endpoint . Conclusion The level of plasma FIB significantly increase in TIA patients with positive composite endpoint , and is posi-tively correlated with ABCD2 score.Using the threshold value of 3.5 g/L for FIB, there was a trend toward FIB predicting outcome of these patients within 90 days after TIA .%目的：探讨血浆纤维蛋白原（ FIB）检测在短暂性脑缺血发作（ TIA）患者预后判断中的应用价值。方法选择急诊入院的132例TIA患者，均进行ABCD2评分，低危患者46例（0～3分），中危患者70例（4～5分），高危患者16例（6～7分）。采用全自动CA7000血凝仪检测TIA患者血浆FIB。患者预后采用复合终点事件来判断，包括在90 d内脑卒中或死亡、与症状相关≥50％大动脉狭窄或有心源性栓子需抗凝治疗。结果未发生复合终点事件98例（阴性组），发生复合终点事件34例（阳性组）。阳性组与阴性组患者血浆FIB水平分别为（4．53±0．99）、（3．05±0．93）g／L，两组比较，P＜0．05。 ABCD2评分为低危、中危、高危患者血浆FIB水平分别为（2．98±0．86）、（3．54±1．47）、（5．16±1．68）g／L，三者间比较，P均＜0．05。相关性分析结果显示，血浆FIB水平与 ABCD2评分呈正相关（r＝0．388，P＜0．001）。 Cox回归分析结果显示，ABCD2≥4分及血浆FIB≥3．5 g／L是TIA患者发生复合终点事件的预测因素（P均＜0．05）。结论 TIA发生复合终点事件者血浆FIB水平明显升高，血浆FIB水平与ABCD2评分呈正相关。血浆FIB≥3．5 g／L时可有效判断90 d内TIA患者预后。