超早期应用阿加曲班治疗急性缺血性脑卒中对凝血酶-抗凝血酶复合物、D-二聚体及预后的影响

Effects of ultra-early treatment of acute ischemic stroke with argatroban on thrombin antithrombin complex,D-dimer,and prognosis

目的:分析超早期应用阿加曲班治疗急性缺血性脑卒中(Acute ischemic stroke,AIS)对凝血酶-抗凝血酶复合物(Thrombin antithrombin,TAT)和D-二聚体水平及预后的影响。方法:收集2018年1月至2021年6月在我院接受治疗的AIS患者147例,其中重组组织型纤溶酶原激活剂(Recombinant tissue plasminogen activator,rt-PA)联合阿加曲班治疗为观察组(n=71),rt-PA单独治疗为对照组(n=76)。治疗前后分别采用化学发光法和免疫比浊法检测患者外周血中TAT和D-二聚体水平;采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和出院90 d改良Rankin量表评分(Modified Rankin Scale,mRS)评价预后,分析治疗后TAT、D-二聚体水平与NIHSS评分的相关性;单因素和多因素logistic回归分析影响患者预后的危险因素;受试者工作曲线(Receiver operating curve,ROC)检测治疗后TAT和D-二聚体水平对患者预后不良的预测价值。结果:与对照组治疗后相比,观察组治疗后TAT和D-二聚体水平降低(P<0.05),NIHSS评分、90 d mRS评分降低(P<0.05),观察组90 d预后良好率较高(P<0.05);治疗后TAT和D-二聚体水平与NIHSS评分均呈正相关(P<0.05);年龄增加、TAT水平增加、D-二聚体水平和NIHSS评分为影响预后不良的独立危险因素(P<0.05);治疗后TAT水平预测AIS预后不良的曲线下面积大于D-二聚体(P<0.05)。结论:AIS超早期应用rt-PA联合阿加曲班可有效降低TAT和D-二聚体水平,改善患者预后。

Objective:To analyze the effects of argatroban on Thrombin antithrombin(TAT)and D-dimer levels and prognosis in the treatment of acute ischemic stroke(AIS)at the ultra-early stage.Methods:A total of 147 AIS patients treated in our hospital from January 2018 to June 2021 were collected.Recombinant tissue plasminogen activator(rtPA)combined with argatroban was treated as the observation group(n=71),and rt-PA alone was treated as the control group(n=76).Chemiluminescence and immunoturbidimetry were used to detect the TAT and D-dimer levels in patient’s peripheral blood before and after treatment.The National Institutes of Health Stroke Scale(NIHSS)score and the Modified Rankin Scale(mRS)score after discharge 90-day were compared between two groups,and the correlation between the TAT,D-dimer levels after treatment and the NIHSS score were analyzed.Univariate and multivariate logistic regression analyses were used to analyze the risk factors affecting the prognosis of patients.The receiver operating curve(ROC)was used to detect the predictive value of TAT and D-dimer levels on poor prognosis of patients after treatment.Results:Compared with the control group after treatment,the levels of TAT and D-dimer in the observation group after treatment were decreased(P<0.05),and the NIHSS score and 90-day mRS score were decreased(P<0.05).After treatment,TAT and D-dimer levels were positively correlated with the NIHSS score(P<0.05).Age increased,TAT level increased,D-dimer level and NIHSS score were independent risk factors for poor prognosis(P<0.05).The area under the curve of TAT level in predicting poor prognosis of AIS after treatment was greater than that of D-dimer(P<0.05).Conclusion:The ultra-early application of rt-PA combined with argatroban in AIS can effectively reduce the levels of TAT and D-dimer and improve the prognosis of patients.