凝血和纤溶功能与卵圆孔未闭合并隐源性卒中的关系

Relationships of coagulation and fibrinolytic functions with patent foramen ovale complicated with cryptogenic stroke

目的分析凝血和纤溶功能与卵圆孔未闭合并隐源性卒中的相关性。方法选取2020年1月—2022年12月收治的100例卵圆孔未闭合并隐源性卒中患者作为观察组,另选取同期100例单纯卵圆孔未闭患者作为对照组。检测2组常规止凝血检测指标、凝血纤溶分子标志物水平;采用多因素Logistic回归模型分析凝血和纤溶功能指标与卵圆孔未闭合并隐源性卒中的相关性;采用受试者工作特征(ROC)曲线分析凝血和纤溶功能指标对卵圆孔未闭患者发生隐源性卒中的预测效能。结果观察组血浆D-二聚体(D-D)、纤维蛋白原溶解产物(FDP)、血栓调节蛋白(TM)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、组织型纤溶酶原激活剂-抑制剂1复合物(t-PAIC)水平均高于对照组,差异有统计学意义(P<0.05);经多因素Logistic回归分析显示,D-D、FDP、TM、TAT、PIC和t-PAIC均是卵圆孔未闭患者发生隐源性卒中的独立预测因素(P<0.05);ROC曲线显示,D-D、FDP、TM、TAT、PIC和t-PAIC预测卵圆孔未闭患者发生隐源性卒中的曲线下面积(AUC)分别0.665、0.680、0.835、0.710、0.680、0.752。结论卵圆孔未闭合并隐源性卒中患者机体凝血和纤溶功能均增强,早期监测凝血和纤溶功能有助于预测隐源性卒中。

Objective To analyze the correlations of coagulation and fibrinolytic functions with patent foramen ovale complicated with cryptogenic stroke.Methods A total of 100 patients with patent foramen ovale and cryptogenic stroke from January 2020 to December 2022 were selected as observation group,and 100 patients with simple patent foramen ovale were selected as control group.Routine anticoagulant indicators and molecular markers of coagulation and fibrinolysis were detected in both groups;the multivariate Logistic regression model was used to analyze the correlations of coagulation and fibrinolytic function indicators with patent foramen ovale complicated with cryptogenic stroke;receiver operating characteristic(ROC)curve was used to analyze the efficiency of coagulation and fibrinolytic function indicators in predicting cryptogenic stroke inpatients with patent foramen ovale.Results Levels of plasma D-dimer(D-D),fibrinogen lysate(FDP),thrombomodulin(TM),thrombinantithrombinⅢcomplex(TAT),plasminase-α2 plasminase inhibitor complex(PIC)and tissue plasminogen activator inhibitor-1 complex(t-PAIC)in the observation group were significantly higher than those in the control group(P<0.05);the Multiple Logistic regressionanalysis showed that D-D,FDP,TM,TAT,PIC and t-PAIC were the independent predictors for cryptogenic stroke in patients with patent foramen ovale(P<0.05);the ROC curve analysis showed the values of area under the curve(AUC)of D-D,FDP,TM,TAT,PIC and t-PAIC in predicting the onset of cryptogenic stroke in patients with patent foramen ovale were 0.665,0.680,0.835,0.710,0.680 and 0.752 respectively.Conclusion Patients with patent foramen ovale and cryptogenic stroke have enhanced coagulation and fibrinolytic functions,and early monitoring of coagulation and fibrinolytic functions can help predict cryptogenic stroke.