Hyperfibrinogenemia and functional outcome from acute ischemic stroke.
Hyperfibrinogenemia and functional outcome from acute ischemic stroke.
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DOI：
10.1161/strokeaha.108.527804
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发表时间：
2009-05
期刊：
影响因子：
8.3
通讯作者：
Ringelstein EB
中科院分区：
文献类型：
--
作者：
del Zoppo GJ;Levy DE;Wasiewski WW;Pancioli AM;Demchuk AM;Trammel J;Demaerschalk BM;Kaste M;Albers GW;Ringelstein EB
流行病学研究发现，血浆纤维蛋白原水平升高与缺血性中风发生率和中风死亡率之间存在密切相关性。关于纤维蛋白原水平对功能性卒中结局的影响知之甚少。分析了来自Ancrod试验（STAT）和欧洲Ancrod试验（ESTAT）卒中治疗的安慰剂数据。在卒中发作后3小时（STAT）或6小时（ESTAT）内以及在静脉输注5天期间的预设时间间隔内测定纤维蛋白原水平。90天时的Barthel指数评分量化了功能结局。采用多元logistic回归分析评价初始纤维蛋白原水平与功能结局之间的相关性。纤维蛋白原水平在前24小时内从治疗前的中位值340 mg/dL逐渐升高至24小时的中位值376 mg/dL。在单变量分析中，STAT（36.0%至26.2%）和ESTAT（53.8%至24.8%）中功能结局良好的患者比例随着初始纤维蛋白原水平四分位数的增加而降低。在多因素分析中，观察到相同的趋势。在两项研究中，初始纤维蛋白原水平<450 mg/dL的患者预后较好; ESTAT组的差异（42.0%对21.6%）显著（P = 0.0006），即使校正了年龄和初始卒中严重程度。较高的初始纤维蛋白原水平与不良结局的独立相关性需要使用更大的急性卒中数据集进行验证。即使在目前的小人群中，这两个变量的明显相关性表明，旨在降低纤维蛋白原水平的治疗在治疗急性缺血性卒中中可能很重要。
Epidemiological studies have found strong correlations between elevated plasma fibrinogen levels and both ischemic stroke incidence and stroke mortality. Little is known about the influence of fibrinogen levels on functional stroke outcome. Placebo data from the Stroke Treatment with Ancrod Trial (STAT) and European Stroke Treatment with Ancrod Trial (ESTAT) were analyzed. Fibrinogen levels were determined within 3 hours (STAT) or 6 hours (ESTAT) of stroke onset and at preset intervals throughout 5 days of intravenous infusions. Barthel Index scores at 90 days quantified functional outcomes. The association between initial fibrinogen levels and functional outcomes was evaluated using a multiple logistic regression analysis. Fibrinogen levels increased gradually over the first 24 hours from a pretreatment median value of 340 mg/dL to a 24-hour median value of 376 mg/dL. In a univariate analysis, the proportion of patients with good functional outcome decreased with increasing quartiles of initial fibrinogen levels in both STAT (36.0% to 26.2%) and ESTAT (53.8% to 24.8%). In a multifactorial analysis, the same trend was observed. Patients with initial fibrinogen levels <450 mg/dL had better outcomes in both studies; the difference (42.0% versus 21.6%) was significant in ESTAT (P = 0.0006), even when corrected for age and initial stroke severity. The independent association of higher initial fibrinogen levels with poor outcome needs to be verified using a larger acute stroke dataset. Even in the present small populations, the apparent association of these 2 variables suggests that treatments designed to reduce fibrinogen levels could potentially be important in treating acute ischemic stroke.