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目的探讨急性缺血性脑卒中(acute ischemic stroke,AIS)不同病情进展及出院结局患者血浆纤维蛋白原和D-二聚体的动态变化。方法连续纳入浙江衢化医院住院治疗的AIS患者335例,比较进展性脑梗死(progressive ischemic stroke,PIS)和出院结局不良组患者与对照组患者血浆纤维蛋白原和D-二聚体的差异,并分析患者一般临床资料。采用SPSS 17.0处理,计量资料采用t检验,计数资料采用χ~2检验,P<0.05为差异有统计学意义。结果 104例患者纳入PIS组,PIS的发生率为31.04%。发病初始(24h内),PIS患者血浆纤维蛋白原(4.42±1.06)g/L和D-二聚体水平(1 376.9±416.6)μg/L高于非PIS患者血浆纤维蛋白原(4.05±0.95)g/L和D-二聚体水平(820.0±324.5)μg/L(P<0.05),并在住院7d内呈进行性升高,然后逐渐降低;同一住院时间点比较,PIS患者纤维蛋白原和D-二聚体水平均高于非PIS组,两组间差异有统计学意义(P<0.05)。76例患者纳入到结局不良组,结局不良发生率为22.69%。结局不良组患者入院时(24h)及住院过程中(3~14d)血浆纤维蛋白原(24h、3d、7d、10d、14d)和D-二聚体水平(24h、3d、7d、10d、14d)均高于结局良好组(P<0.05)。PIS组患者合并糖尿病和冠心病史的发病率高于非PIS组(χ~2=6.276、5.674,P<0.05),结局不良组患者的年龄及合并糖尿病、冠心病、房颤的发病率高于结局良好组(χ~2=6.769、5.132、4.800,P<0.05)。结论血浆纤维蛋白原、D-二聚体入院时和住院期间维持较高水平可能预示着急性缺血性脑卒中患者病情进展和出院不良结局,但可能会受到其他因素的影响。
Objective To investigate the dynamic changes of plasma fibrinogen and D-dimer in patients with acute ischemic stroke (AIS) with different disease progression and discharge. Methods A total of 335 AIS patients hospitalized in Quhua Hospital of Zhejiang Province were included in this study. The differences of plasma fibrinogen and D-dimer between patients with progressive ischemic stroke (PIS) and those with poor outcome were compared. And analyze the general clinical data of patients. Using SPSS 17.0 treatment, measurement data using t test, count data using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results 104 patients were included in the PIS group, the incidence of PIS was 31.04%. Plasma fibrinogen (4.42 ± 1.06) g / L and D-dimer level (P = 376.9 ± 416.6) μg / L in PIS patients were significantly higher than those in non-PIS patients (4.05 ± 0.95 ), g / L and D-dimer (820.0 ± 324.5) μg / L (P <0.05), and increased progressively within 7 days of hospitalization and then gradually decreased. Compared with the same hospitalization time, fibrin The original and D-dimer levels were higher than non-PIS group, the difference between the two groups was statistically significant (P <0.05). Sixty-six patients were enrolled in the unfavorable outcome group with a negative outcome rate of 22.69%. Patients in the poor outcome group had significantly lower levels of fibrinogen (24h, 3d, 7d, 10d, 14d) and D-dimer at 24h, 3d, 7d, 10d, 14d ) Were higher than the good outcome group (P <0.05). The incidence of diabetes mellitus and coronary heart disease in PIS group was higher than that in non-PIS group (χ ~ 2 = 6.276, 5.674, P <0.05). The incidence of diabetes mellitus, coronary heart disease and atrial fibrillation in patients with poor outcome was significantly higher Good outcome in the group (χ ~ 2 = 6.769,5.132,4.800, P <0.05). Conclusions The maintenance of high levels of plasma fibrinogen and D-dimer at admission and during hospitalization may predict the progression of disease and the adverse outcome of discharge in patients with acute ischemic stroke, but may be affected by other factors.