摘要
目的：探究纤维蛋白原（Fib）在急性脑梗死 TOAST 分型[大动脉粥样硬化（LAA）型和小动脉闭塞（SAO）型]中的水平变化及诊断价值。方法选择2012年6月至2013年6月住院的首次发病24 h 内的急性脑梗死患者117例及同期在门诊体检的正常健康者40例。所有患者于入院后1 h 内完善 Fib 水平测定及 NIHSS 评分，然后完善影像学、超声学及其他实验室检查。结果 LAA、SAO 两亚型及正常健康组 Fib 水平分别为（3.51±0.74）、（3.00±0.73）、（2.53±0.16）g/ L。LAA、SAO 两亚型 Fib 水平均较正常健康组高，LAA 型水平最高，两组间比较差异有统计学意义（P 〈0.05）；LAA、SAO 两亚型 NIHSS 分值分别为7.29±5.29和3.13±1.13，LAA 型高于SAO 型，两型间比较差异有统计学意义（P =0.035）；Fib 水平与 NIHSS 分值呈正相关（r =0.639，P =0.013）。回归方程为 NIHSS =-5.224＋3.646Fib；ROC 曲线确立 Fib≥3.00 g/ L 判断为 LAA 型的灵敏度为60.1%，特异度为73.4%，阳性预测值为81.8%，阴性预测值为43.5%。结论 Fib 水平可协助急性脑梗死的早期病因学分型，尤其对 LAA 型的预测有一定的诊断价值。同时可在一定程度上反映脑梗死的严重程度。
Objective To investigate the levels changes and diagnostic value of fibrinogen in the TOAST etiology classification of acute cerebral infarction[ large-artery atherosclerosis（ LAA）and small-artery occlusion（SAO）]. Methods From June 2012 to June 2013,117 patients with acute cere-bral infraction within 24 h after the first onset of symptoms and 40 healthy controls were chose. The plas-ma concentration of fibrinogen was detected and NIHSS was scored within 1 h on admission. Then,the imaging,ultrasound and other laboratory tests were given. Results The mean plasma concentration of fi-brinogen in LAA group and SAO group was respectively（3. 51 ± 0. 74）g / L,（3. 00 ± 0. 73）g / L,and （2. 53 ± 0. 16）g / L in the control group. The fibrinogen levels were significantly higher in LAA group than that in SAO group,however,that in both group were higher than that in the control group（P 〈 0. 05）. The mean NIHSS score in LAA group and SAO group was respectively 7. 29 ± 5. 29 and 3. 13 ± 1. 13, there was significant difference（P = 0. 035）. And fibrinogen level was positively correlated with NIHSS scores（r = 0. 639,P = 0. 013）,the regression equation was NIHSS = -5. 224 ＋ 3. 646Fib. The fibrinogen ROC curves showed that the cutoff value which could get the best sensitivity and specificity for differentia-ting LAA from SAO was 3. 00 g / L,and with a sensitivity of 60. 1% ,specificity of 73. 4% ,positive pre-dictive value of 81. 8% ,negative predictive value of 43. 5% . Conclusions Fibrinogen level can be a useful indicator for identifying the early etiological subtypes of acute cerebral infraction,especially for predicting LAA. And it can reflect the severity of cerebral infarction in certain degree.
出处
《中国实用医刊》
2014年第14期15-17,共3页
Chinese Journal of Practical Medicine
