纤维蛋白原与白蛋白比值预测接受静脉溶栓的急性缺血性卒中患者转归

Fibrinogen-to-albumin ratio predicts the outcome of patients with acute ischemic stroke receiving intravenous thrombolysis

目的探讨纤维蛋白原/白蛋白比值(fibrinogen to albumin ratio,FAR)与急性缺血性卒中患者静脉溶栓后临床转归的相关性及预测价值。方法回顾性纳入2019年11月至2022年8月在阜阳市人民医院接受静脉溶栓治疗的急性缺血性卒中患者,收集临床、影像学和实验室资料。在发病3个月后采用改良Rankin量表进行临床转归评估,>2分定义为转归不良。应用多变量logistic回归分析确定FAR与转归不良的相关性。采用受试者工作特征曲线评估FAR对急性缺血性卒中患者静脉溶栓后转归不良的预测价值。结果共纳入162例患者,转归良好组114例(70.4%),转归不良组48例(29.6%)。单变量分析表明,转归不良组基线美国国立卫生研究院卒中量表(Naitonal Institutes of Health Stroke Scale,NIHSS)评分、空腹血糖、纤维蛋白原和FAR显著高于转归良好组,而血清白蛋白显著低于转归良好组(P均<0.05)。多变量logistic回归分析表明,基线NIHSS评分[优势比(odds ratio,OR)1.176,95%置信区间(confidence interval,CI)1.082~1.227;P<0.001]、空腹血糖(OR 1.206,95%CI 1.018~1.430;P=0.030)和FAR(OR 1.448,95%CI 1.449~1.824;P=0.002)是转归不良的独立危险因素。受试者工作特征曲线分析显示,FAR预测转归不良的曲线下面积为0.706(95%CI 0.616~0.796),当FAR截断值为8.06时,敏感性和特异性分别为66.7%和78.2%。结论FAR与急性缺血性卒中患者静脉溶栓治疗后转归存在显著相关性,FAR较高对患者转归不良具有一定的预测价值。

Objective To investigate the correlation and predictive value of fibrinogen-to-albumin ratio(FAR)and clinical outcomes after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis treatment at Fuyang People's Hospital from November 2019 to August 2022 were retrospectively included.Their clinical,imaging,and laboratory data were collected.After 3 months of onset,a modified Rankin Scale was used for clinical outcome evaluation and a score>2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine the correlation between FAR and poor outcome.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of FAR on adverse outcomes after intravenous thrombolysis in patients with acute ischemic stroke.Results A total of 162 patients were included.There were 114 patients(70.4%)in the good outcome group and 48(29.6%)in the poor outcome group.Univariate analysis showed that the baseline National Institutes of Health Stroke Scale(NIHSS)score,fasting blood glucose,fibrinogen,and FAR in the poor outcome group were significantly higher than those in the good outcome group,while the serum albumin was significantly lower than that of the good outcome group(all P<0.05).Multivariate logistic regression analysis showed that the baseline NIHSS score(odds ratio[OR]1.176,95%confidence interval[CI]1.082-1.227;P<0.001),fasting blood glucose(OR 1.206,95%CI 1.018-1.430;P=0.030),and FAR(OR 1.448,95%CI 1.449-1.824;P=0.002)were the independent risk factors for poor outcome.The ROC curve analysis showed that the area under the curve of FAR for predicting poor outcomes was 0.706(95%CI 0.616-0.796).When the FAR cutoff value was 8.06,the sensitivity and specificity were 66.7%and 78.2%,respectively.Conclusion There is a significant correlation between FAR and outcomes after intravenous thrombolysis therapy in patients with acute ischemic stroke.Higher FAR has certain predictive value for poor outcomes of patients.