AFR和FPR与急性缺血性脑卒中患者临床预后的关系

Association between AFR, FPR and clinical outcome of cerebral ischemic stroke patients

目的探讨白蛋白(Alb)与纤维蛋白原(Fib)比值(AFR)及Fib与前白蛋白(pAlb)比值(FPR),与急性缺血性脑卒中患者临床预后的关系。方法依据急诊缺血性脑卒中诊断指南纳入180例首诊患者,分别测定血清Alb、pAlb和Fib水平,对患者进行为期3年的随访,并采用Kaplan-Meier曲线和Cox回归模型分析AFR、FPR与患者预后的关系。结果 180例急性缺血性脑卒中患者经3年随访后,出现复发39例,因脑卒中死亡30例,其中未复发、复发和死亡患者治疗前FPR比值相继显著升高,Kaplan-Meier曲线分析显示治疗前高FPR和低AFR与患者无复发生存期和总生存期显著相关,而时间依赖ROC曲线分析发现FPR用于此类患者生存预后预测效能显著高于其他指标,经过多因素校正后FPR与急性缺血性脑卒中患者复发(校正HR=6.71,95%CI:2.80～16.06)和死亡(校正HR=6.47,95%CI:3.02～12.46)显著相关。结论 FPR和与急性缺血性脑卒中患者再发病和出院预后结局显著相关,可作为判断急性缺血性脑卒中患者出院预后结局的独立预测指标。

Objective To investigate the association between serum albumin/fibrinogen ratio(AFR),fibrinogen/prealbumin ratio(FPR)and clinical outcome of cerebral ischemic stroke patients.Methods One hundred and eighty patients with cerebral ischemic stroke were included in the study.Serum albumin(Alb),prealbumin(pAlb)and fibrinogen(Fib)were determined with bromo cresol green method,transmission turbidimetry and solidification method,respectively.Patients were followed-up for three years,and Kaplan-Meier curve and Cox regression model were applied to analysis the prognostic value of AFR and FPR.Results During the 3-year follow-up disease recurrence occurred in 39 cases,and 30 cases died.The FPR was increased in the order of non-recurrent,recurrent and dead patients.Kaplan-Meier curve showed that pretreatment high FPR and low AFR were significantly associated with recurrence-free survival and overall survival of patients.Time-dependent receiver operating characteristic(RPC)curve indicated that the predicted efficacy of FPR was significant higher than other biomarkers,and it was significantly associated with recurrence(adjusted HR=6.71,95%CI:2.80~16.06)and death(adjusted HR=6.47,95%CI:3.02~12.46).Conclusion Circulating FPR is associated with recurrence and prognosis of the patients,and it may be use as an independent biomarker to predict clinical outcome of the patients with acute ischemic stroke.