纤维蛋白原联合NIHSS评分预测经静脉溶栓的急性缺血性卒中病人的预后

颜谈; 王阿会; 王幼萌; 张艳

doi:10.13898/j.cnki.issn.2097-5252.2025.08.015

纤维蛋白原联合NIHSS评分预测经静脉溶栓的急性缺血性卒中病人的预后

Study on the predictive value of fibrinogen combined with NIHSS score in the prognosis of acute ischemic stroke patients treated with intravenous thrombolysis

摘要

摘要: 目的: 探究溶栓前纤维蛋白原(FIB)、溶栓前NIHSS评分与静脉溶栓(IVT)治疗后急性缺血性卒中(AIS)病人的近中期预后关系及二者联合对预后的预测效能。方法: 收集167例IVT治疗的AIS病人。根据mRS评分，将发病后3个月预后情况分为预后良好组(n=123)和预后不良组(n=44)。利用单因素分析比较2组病人人口统计学及临床资料。利用多因素logistic回归分析探索可能影响预后的独立影响因素。ROC曲线分析溶栓前FIB、溶栓前NIHSS评分对近中期预后的预测效能。结果: 167例中男107例，女60例，平均年龄(62.10±11.76)岁；发生早期神经功能恶化(END)28例，出现出血转化3例，没有出现症状性出血转化；预后良好123例，预后不良44例。单因素分析显示，预后不良组病人的美国国立卫生研究院卒中量表(FIB)、NIHSS评分、溶栓前收缩压均偏高，发生END例数、TOAST分型中大动脉粥样硬化型所占比例多于预后良好组，差异均有统计学意义(P < 0.05~P < 0.01)。回归分析显示溶栓前FIB水平高、溶栓前NIHSS评分高、发生END可能为AIS近中期不良预后的独立危险因素(P < 0.01)。ROC曲线分析显示，溶栓前FIB、溶栓前NIHSS评分各自及联合对预后的预测效能曲线下面积分别是0.655、0.726、0.868。结论: 溶栓前FIB、溶栓前NIHSS评分是IVT治疗后AIS病人预后不良的独立危险因素，两者联合对近中期预后的预测效能显著提高。

Abstract: Objective: To explore the association between pre-thrombolytic fibrinogen (FIB), pre-thrombolytic NIHSS score and near-and medium-term prognosis in acute ischemic stroke(AIS) patients treated with intravenous thrombolysis(IVT), and the predictive efficacy of combining two variables for prognosis. Methods: A total of 167 IVT-treated AIS patients were collected.According to the mRS score, the patients were divided into the good prognosis group(n=123) and poor prognosis group(n=44) at 3 months after onset.The demographic and clinical data between two groups were compared with univariate analysis.Multivariate logistic regression analysis was used to explore the independent factors influencing prognosis.ROC curve was used to analyze the predictive efficacy of FIB and NIHSS score before thrombolysis for near-and medium-term prognosis. Results: A total of 167 subjects were included in this study, including 107 males and 60 females, with an average age of (62.10±11.76) years.There were 28 cases of early neurological deterioration(END), 3 cases of hemorrhagic transformation occurred, and no symptomatic hemorrhagic transformation occurred.There were 123 cases with a good prognosis and 44 cases with a poor prognosis.The results of univariate analysis showed that the FIB, NIHSS score and systolic blood pressure of patients in the poor prognosis group before thrombolysis were higher.The number of END cases and proportion of large artery atherosclerotic type in the TOAST classification in the poor prognosis group were higher than those in good prognosis group(P < 0.05 to P < 0.01).The regression analysis showed that the high FIB level and high NIHSS score before thrombolysis and occurrence of END might be independent risk factors of poor prognosis in the near-and medium-term of AIS(P < 0.01).ROC curve analysis showed that the areas under the curve of the predictive efficacy of pre-thrombolysis FIB, pre-thrombolysis NIHSS score and their combination for prognosis were 0.655, 0.726, and 0.868, respectively. Conclusions: The pre-thrombolysis FIB and pre-thrombolysis NIHSS score are the independent risk factors of poor prognosis in AIS patients treated with intravenous thrombolysis.The combination of the two variables can significantly improve the prediction efficiency of near-and medium-term prognosis.

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