凝血功能改变与新型冠状病毒感染后发生急性缺血性脑卒中相关

Changes of coagulation function are associated with acute ischemic stroke after coronavirus disease 2019

目的比较新型冠状病毒感染(COVID-19)与非COVID-19的急性缺血性脑卒中患者的临床特点、炎症指标及凝血功能,探讨COVID-19后发生急性缺血性脑卒中的危险因素。方法采用单中心回顾性研究设计,纳入2022年11月5日至2023年2月5日于我院接受治疗且完善COVID-19病毒核酸检测的急性缺血性脑卒中患者187例,其中COVID-19患者75例(COVID-19组)、未发生COVID-19患者112例(非COVID-19组)。分析两组患者的一般临床资料、炎症和凝血功能指标,包括中性粒细胞/淋巴细胞比值(NLR)、D-二聚体、纤维蛋白原(FIB)等。采用多因素logistic回归模型分析COVID-19后发生急性缺血性脑卒中的独立危险因素。结果COVID-19组的NLR[3.62(2.31,6.71)vs 2.64(1.87,5.04),P=0.014]、D-二聚体[0.70(0.32,2.27)mg/L vs 0.37(0.27,0.76)mg/L,P=0.001]、FIB[4.21(3.26,5.17)g/L vs 3.25(2.77,3.87)g/L,P<0.001]高于非COVID-19组,淋巴细胞计数[1.40(1.03,1.71)×10^(9)/L vs 1.61(1.09,2.21)×10^(9)/L,P<0.05]低于非COVID-19组。多因素logistic回归分析结果表明,既往脑卒中史(OR=5.430,95%CI 1.538~19.175,P=0.009)、D-二聚体(OR=1.425,95%CI 1.104~1.840,P=0.007)及FIB(OR=2.405,95%CI 1.683~3.437,P<0.001)是COVID-19后发生急性缺血性脑卒中的独立危险因素。结论COVID-19后急性缺血性卒中患者的炎症和凝血功能的血清生物标志物NLR、D-二聚体、FIB水平升高。COVID-19后缺血性脑卒中的发病与高凝状态相关。

Objective To compare the clinical characteristics,inflammatory indexes and coagulation function of patients with acute ischemic stroke complicated with coronavirus disease 2019(COVID-19)and those without COVID-19,and to explore the risk factors of acute ischemic stroke after COVID-19.Methods A single-center retrospective study was conducted in 187 patients with acute ischemic stroke who were treated in our hospital from Nov.5,2022 to Feb.5,2023 and were tested for COVID-19,including 75 patients with COVID-19(COVID-19 group)and 112 patients without COVID-19(non-COVID-19 group).The general clinical data,inflammation and coagulation function indexes(neutrophil-lymphocyte ratio[NLR],D-dimer,and fibrinogen[FIB])of the 2 groups were analyzed.Multivariate logistic regression was used to analyze the independent risk factors of acute ischemic stroke after COVID-19 infection.Results NLR(3.62[2.31,6.71]vs 2.64[1.87,5.04],P=0.014),D-dimer(0.70[0.32,2.27]mg/L vs 0.37[0.27,0.76]mg/L,P=0.001)and FIB(4.21[3.26,5.17]g/L vs 3.25[2.77,3.87]g/L,P<0.001)of COVID-19 group were markedly higher than those of non-COVID-19 group,and lymphocyte count(1.40[1.03,1.71]×10^(9)/L vs 1.61[1.09,2.21]×10^(9)/L,P<0.05)was lower than that of non-COVID-19 group.Multivariate logistic regression analysis showed that the previous stroke history(odds ratio[OR]=5.430,95%confidence interval[CI]1.538-19.175,P=0.009),D-dimer(OR=1.425,95%CI 1.104-1.840,P=0.007)and FIB(OR=2.405,95%CI 1.683-3.437,P<0.001)were independent risk factors for acute ischemic stroke after COVID-19.Conclusion Serum biomarkers of inflammation and coagulation function(NLR,D-dimer,and FIB)are increasesd in patients with acute ischemic stroke after COVID-19,and the incidence of ischemic stroke after COVID-19 is related to hypercoagulability.