纤维蛋白原/白蛋白比值预测老年急性缺血性卒中血管内治疗术后预后不良的价值

Correlation between fibrinogen to albumin ratio and poor prognosis 90 days after endovascular treatment in elderly patients with acute ischemic stroke

目的本研究旨在探索纤维蛋白原/白蛋白比值(fibrinogen to albumin ratio,FAR)对老年急性缺血性卒中病人血管内治疗术后预后不良的预测作用。方法纳入自2015年5月至2018年11月南京市第一医院神经内科收治的接受血管内治疗的老年急性前循环大血管闭塞性缺血性卒中病人,回顾性分析其临床资料以及预后情况,比较转归良好组与转归不良组基线资料。采用多元Logistic回归分析血管内治疗术后90 d预后不良的独立危险因素,并使用ROC曲线分析FAR水平对血管内治疗后90 d转归不良的预测价值。结果转归不良组的年龄(P=0.001)、卒中史(P=0.003)、基线NIHSS评分(P=0.001)、ASITN/SIR侧支循环分级0~2级比例(P=0.019)、症状性颅内出血(sICH)构成比(P=0.037)、FPG水平(P=0.001)、FAR水平(P=0.001)均显著高于转归良好组,Hcy水平(P=0.034)显著低于转归良好组。多因素Logistic回归校正年龄、卒中史、基线NIHSS评分、侧支循环分级0~2级比例、sICH、FPG水平、Hcy水平等混杂因素后显示,FAR是血管内治疗术后90 d转归不良的独立危险因素(OR=25.048,95%CI8.938~44.733,P=0.001)。FAR预测血管内治疗术后90 d转归不良的AUC为0.711,最佳截断值为0.0868,此时的敏感度和特异度分别为60.72%和77.88%。结论FAR增高可用于预测老年急性缺血性卒中病人血管内治疗术后90 d转归不良。

Objective To investigate the predicting value of the ratio of fibrinogen to albumin(FAR)for the adverse prognosis in the elderly patients with acute ischemic stroke receiving endovascular treatment.Methods The clinical data of the elderly patients who received endovascular treatment of anterior circulation in Nanjing First Hospital were collected,prospectively,from May 2015 to November 2018.The outcome of the patients was evaluated 90 days after treatment,and they were divided into good prognosis group and poor prognosis group.The baseline data were compared between the two groups.The influencing factors of prognosis were investigated by the multivariate Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of FAR to the poor prognosis after 90 days.Results The age,history of stroke,baseline NIHSS score,ASITN/SIR collateral circulation grade 0-2,symptomatic intracranial hemorrhage,fasting blood glucose and FAR in the poor prognosis group were significantly higher than those in the good prognosis group,and the level of homocysteine in the poor prognosis group was lower(P<0.05).Multivariate Logistic regression showed that FAR(OR=25.048,95%CI8.938-44.733)was an independent predictor of poor prognosis after 90 days,after adjusting for the confounding factors including age,history of stroke,baseline NIHSS score,ASITN/SIR collateral circulation grade 0-2,symptomatic intracranial hemorrhage,fasting blood glucose and homocysteine.The area under the ROC curve of the FAR for predicting poor prognosis after 90 days was 0.711(95%CI 0.645-0.772,P<0.001).The sensitivity and specificity of predicting the poor prognosis were 60.23%and 84.17%,and the optimal cut-off value of FAR was 0.0868.Conclusions The increasing FAR level may be able to predict poor outcome at 90 days in the elderly patients with acute ischemic stroke undergoing the endovascular treatment of anterior circulation.