阿替普酶溶栓后纤维蛋白降解产物、D-二聚体、血小板与中性粒细胞比值水平对急性脑梗死预后有预测价值

王宝伟.阿替普酶溶栓后纤维蛋白降解产物、D-二聚体、血小板与中性粒细胞比值水平对急性脑梗死预后有预测价值[J].内科急危重症杂志,2025,31(3):220-225

DOI：10.11768/nkjwzzzz20250305

中文关键词: 急性脑梗死阿替普酶纤维蛋白降解产物 D-二聚体血小板中性粒细胞病情转归预测

英文关键词:

基金项目:

作者	单位	E-mail
王宝伟	山东第二医科大学	haixing_ok@163.com

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中文摘要:

摘要目的：分析急性脑梗死（ACI）阿替普酶溶栓后纤维蛋白降解产物（FDP）、D-二聚体（D-D）、血小板与中性粒细胞比值（PNR）变化，探讨其对病情转归的预测价值。方法：选取收治的100例ACI患者，根据阿替普酶溶栓后30 d病情转归情况分为不良组（33例）和良好组（67例）。比较2组基线资料及溶栓前、溶栓24 h后FDP、D-D及PNR变化。分析FDP、D-D、PNR与改良Rankin量表（mRS）评分的相关性。评价溶栓后24 h FDP、D-D、PNR对溶栓后30 d病情转归的预测效能。结果：与本组溶栓前比较，溶栓24 h后不良组FDP、D-D升高，PNR降低（P均＜0.05）；不良组溶栓前和溶栓24 h后FDP、D-D高于良好组，PNR低于良好组（P均＜0.05）。溶栓前、溶栓后24 h FDP、D-D与mRS评分呈正相关（r溶栓前=0.720、0.853，P均＜0.001；r溶栓后24 h=0.808、0.911，P均＜0.001），PNR与mRS评分呈负相关（r溶栓前=-0.784，P＜0.001；r溶栓后24 h =-0.855，P＜0.001），且溶栓后24 h相关性更高（P＜0.05）；偏相关性分析显示，排除其他混杂变量后，溶栓后24 h FDP、D-D、PNR与mRS评分的相关性仍存在（偏相关性系数=0.800、0.897、-0.836，P均＜0.001）；多因素Logistic回归分析显示，校正了年龄、发病至就诊时间后，FDP、D-D、PNR仍是ACI病情转归的独立相关影响因素（P均＜0.05）；溶栓后24 h FDP、D-D、PNR单项及三项联合预测溶栓后30 d病情转归不良的AUC分别为0.744、0.809、0.835、0.902。结论：ACI患者阿替普酶溶栓后联合FDP、D-D、PNR水平对病情转归判断有指导意义。

英文摘要:

Abstract Objective: To analyze the changes of fibrin degradation products (FDP), D-Dimer (D-D) and platelet neutrophil ratio (PNR) after alteplase thrombolysis in patients with acute cerebral infarction (ACI), and to explore its predictive value for the disease outcome. Methods: A total of 100 patients with ACI treated in our hospital were selected and assigned to a poor prognosis group (33 cases) and a good prognosis group (67 cases) according to the disease outcome after alteplase thrombolytic therapy. The baseline data and the changes of FDP, D-D and PNR before and 24 h after thrombolysis were compared between the two groups. The correlation between FDP, D-D, PNR and mRS scores was analyzed. The predictive efficacy of FDP, D-D and PNR at 24 h after thrombolysis on the disease outcome at 30 d after thrombolysis was evaluated. Results: Compared with those before thrombolysis, FDP and D-D increased and PNR decreased in the poor prognosis group at 24 h after thrombolysis (both P< 0.05); the FDP and D-D in the poor prognosis group were higher than those in the good prognosis group before and 24 h after thrombolysis, and the PNR was lower than that of the good prognosis group (both P< 0.05). Before and 24 h after thrombolysis, FDP, D-D, and mRS scores were positively correlated (rbefore thrombolysis= 0.720, 0.853, all P< 0.001; r24 h after thrombolysis= 0.808, 0.911, all P< 0.001), PNR was negatively correlated with mRS score (rbefore thrombolysis= -0.784, P< 0.001; r24 h after thrombolysis= -0.855, P< 0.001), and the correlation was even higher at 24 h after thrombolysis (P< 0.05). Partial correlation analysis showed that after excluding other confounding variables, the correlation between FDP, D-D, PNR at 24 h after thrombolysis and mRS scores still existed (partial correlation coefficients= 0.800, 0.897, -0.836, all P< 0.001). Multivariate Logistic regression analysis showed that after adjusting for age and the time from onset to treatment, FDP, D-D, and PNR were still independent factors associated with the prognosis of ACI (all P< 0.05); the AUC of FDP, D-D, PNR, and their combination for predicting poor disease outcome at 30 th day after thrombolysis were 0.744, 0.809, 0.835, and 0.902, respectively. Conclusion: FDP, D-D and PNR after alteplase thrombolysis in ACI patients are closely related to the disease outcome, and they have certain predictive value for the disease outcome, and the combined detection of their levels has guiding significance for the disease outcome judgment and treatment decision.