Increased fibrinogen levels and acquired hypofibrinolysis in young adults with ischemic stroke
Increased fibrinogen levels and acquired hypofibrinolysis in young adults with ischemic stroke
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DOI：
10.1161/01.str.29.11.2261
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发表时间：
1998-11-01
期刊：
影响因子：
8.3
通讯作者：
Olsson, T
中科院分区：
文献类型：
--
作者：
Kristensen, B;Malm, J;Olsson, T
背景和目的：纤维蛋白原水平升高和纤溶系统异常与心血管事件的发生有关。然而，这些因素在脑血管疾病演变中的作用却很少受到关注，特别是在年轻中风患者中。本研究的目的是评估首次缺血性中风的年轻人血浆纤维蛋白原水平和纤维蛋白溶解系统状态的可能异常。方法：本研究基于1991年1月至1996年5月期间因首次缺血性中风而入院的102例年龄在18至44岁的连续患者。招募了41名健康对照者。入院后大于或等于3个月（平均5.4+/-2.0个月）对人体测量/代谢变量、血浆纤维蛋白原水平和纤维蛋白溶解系统进行评估。结果：患者在基线时组织型纤溶酶原激活剂活性较低，1型纤溶酶原激活剂抑制剂活性升高，在基线和静脉闭塞试验后组织型纤溶酶原激活剂质量浓度均升高。总的来说，在血浆纤维蛋白原水平和纤维蛋白溶解变量方面，主要病因亚组之间没有显著差异。基线纤溶变量与体重指数、血清甘油三酯和胆固醇水平密切相关。在多变量模型调整后，患者在基线和静脉闭塞试验后的纤维蛋白原水平和组织纤溶酶原激活物质量浓度仍显著升高。Logistic多元回归分析表明，血浆纤维蛋白原是缺血性卒中的重要预测因子（优势比11.25;95% CI 3.27 ~ 38.69）。结论：纤维蛋白原水平和组织纤溶酶原激活剂质量浓度的升高与青壮年缺血性卒中独立相关。代谢紊乱与这些患者组织纤溶酶原激活物和纤溶酶原激活物抑制剂1型活性异常密切相关，结果与获得性低纤溶一致。
Background and Purpose-Elevated fibrinogen levels and abnormalities in the fibrinolytic system are related to the occurrence of cardiovascular events. However, the role of these factors in the evolution of cerebrovascular disease has received less attention, in particular in young stroke patients. The aim of this study was to evaluate possible abnormalities in plasma fibrinogen levels and the state of the fibrinolytic system in young adults with a first-ever ischemic stroke.Methods-This study is based on 102 consecutive patients aged 18 to 44 years admitted between January 1991 and May 1996 as a result of a first ischemic stroke. Forty-one healthy controls were recruited. Evaluations of anthropometric/metabolic variables, plasma fibrinogen levels, and the fibrinolytic system were undertaken greater than or equal to 3 months (mean, 5.4+/-2.0 months) after admission.Results-Patients had lower tissue plasminogen activator activity and increased plasminogen activator inhibitor type 1 activity at baseline, as well as increased tissue plasminogen activator mass concentration both at baseline and after a venous occlusion test. Overall, there were no significant differences between the main etiologic subgroups regarding plasma fibrinogen levels and fibrinolytic variables. Baseline fibrinolytic Variables were strongly correlated with body mass index, serum triglycerides, and cholesterol levels. After adjustments in multivariate models, fibrinogen levels and tissue plasminogen activator mass concentration both at baseline and after venous occlusion test remained significantly increased in patients. Logistic multiple regression analyses indicated that plasma fibrinogen was a strong predictor of ischemic stroke (odds ratio, 11.25; 95% CI, 3.27 to 38.69).Conclusions-Increased fibrinogen levels and tissue plasminogen activator mass concentration are independently associated with ischemic stroke in young adults. Metabolic perturbations are closely interrelated with aberrations in tissue plasminogen activator and plasminogen activator inhibitor type 1 activity in these patients, findings consistent with an acquired hypofibrinolysis.