血浆纤维蛋白原浓度对首次缺血性卒中后1年内卒中复发的影响：前瞻性病例系列研究

Effect of plasma fibfinogen concentration on stroke recurrence within one year of first-ever ischerrdc stroke： a prospective case series study

目的探讨血浆纤维蛋白原（fibrinogen，Fib）水平对首次缺血性卒中后1年内卒中复发的影响。方法前瞻性收集首次急性缺血性卒中患者，至少随访1年。将患者分为复发组与未复发组，采用多变量logistic回归分析探索首次缺血性卒中患者1年内复发的危险因素；根据发病初血浆Fib水平，将患者分为高Fib组和正常Fib组，采用Kaplan-Meier生存分析法比较两组患者复发率。结果共纳入121例首次急性缺血性卒中患者，111例完成1年随访，其中30例（27．027％）复发。多变量logistic回归分析显示，血浆Fib水平高[优势比（oddsratio，OR）13．238，95％可信区间（confidenceinterval，CI）1．152～152．077；P=0．038]、初次发病年龄大（OR1．321，95％c，1．064～1．641；P=0．012）、体质指数高（OR1．351，95％CI1．001～1．823；P=0．049）、服用抗血小板药（OR36．819，95％CI1．890～717．143；P=0．017）和降血压药（OR50．765，95％C13．198～805．878；P=0．005）依从性差是初次缺血性卒中患者短期复发的独立危险因素。Kaplan-Meier生存函数曲线显示，高Fib组卒中复发率显著性高于正常Fib组（Log-Rank检验，P=0．000）。结论血浆Fib水平增高、高龄、肥胖以及服用抗血小板药和降血压药依从性差是初次缺血性卒中患者短期复发的独立危险因素。

Objective To investigate the effect of plasma fibrinogen （Fib） level on stroke recurrence within one year of first-ever ischemic stroke. Methods The patients with first-ever acute ischemic stroke were enrolled prospectively and were followed up for at least one year. They were divided into either a recurrent group or a non-recurrent group. Multivariate logistic regression analysis was used to explore the risk factors for stroke recurrence within one year of first-ever ischemic stroke. According to the plasma Fib levels of the early onset, the patients were divided into a high Fib group and a normal Fib group. Kaplan-Meier survival analysis was used to compare the recurrence between the two groups.Results A total of 121 patients with first-ever acute ischemic stroke were enrolled, 111 completed one year follow up, and 30 of them （27. 027%） had recurrent stroke. Multivariate logistic regression analysis showed that the increased plasma Fib level （odds ratio [ OR] 13. 238, 95% confidence interval [ CIJ 1. 152 - 152. 077; P = O. 038）, older at the first onset （OR 1. 321, 95% C1 1. 064 - 1. 641; P =0. 012）, high body mass index （OR 1. 351, 95% C1 1. 001 - 1. 823; P = O. 049）, and poor compliance of antiplatelet drugs （OR 36. 819, 95% CI 1. 890 - 717. 143; P = 0. 017） and antihypertensive drugs （OR 50. 765, 95% CI 3. 198 -805. 878; P =0. 005） were the dependent the risk factors for stroke recurrence within one year of first-ever ischemic stroke. Kaplan-Meier survival function curves showed that the recurrence rate of stroke in the high Fib group was significantly higher than that in the normal Fib group （Log-rank test, P = O. 000）. Conclusions The increased high plasma Fib level, advanced age, obesity,as well as poor compliance of antiplatelet drugs and antihypertensive drugs were the independent risk factors for stroke recurrence within one year of first-ever ischemic stroke.