血浆纤维蛋白降解产物对出血性脑卒中患者早期预后的评估价值

doi:10.3969/j.issn.1674-8115.2021.05.008

摘要/Abstract

摘要：

目的·探讨血浆纤维蛋白降解产物（fibrin degradation product，FDP）对出血性脑卒中（hemorrhagic stroke，HS）发病14 d内死亡风险的评估价值。方法·回顾性研究上海交通大学医学院附属瑞金医院北院急诊科2017年5月1日—2020年5月1日收治的HS患者的一般资料、基线实验室指标、手术情况及14 d预后信息，分析患者14 d预后的相关因素，并进行多因素Logistic回归分析。根据出血部位，将患者分为脑内出血（intracerebral hemorrhage，ICH）组、原发性脑室出血（primary intraventricular hemorrhage，PIVH）组和蛛网膜下腔出血（subarachnoid hemorrhage，SAH）组；将ICH组再分为单纯血肿亚组、合并脑室出血（intraventricular hemorrhage，IVH）亚组、合并SAH亚组、合并IVH和SAH亚组。分别分析各组、各亚组14 d内死亡和存活患者血浆FDP水平的差异。结果·共纳入HS患者606例，平均年龄为（58.9±15.1）岁，其中男性405例，女性201例；ICH组493例，PIVH组32例，SAH组81例；ICH组中单纯血肿亚组254例，合并IVH亚组142例，合并SAH亚组49例，合并IVH和SAH亚组48例。共有124例患者接受手术治疗，有85例患者在发病14 d内死亡。与14 d内存活的HS患者血浆FDP水平［1.12（0.70，2.23）μg/mL］相比，14 d内死亡患者的血浆FDP水平［2.07（0.92，5.65）μg/mL］显著升高（P=0.000）。多因素Logistic回归分析显示，血浆FDP>2.78 μg/mL是HS患者14 d内死亡的独立危险因素（OR=2.564，P=0.001）。分组分析发现，在ICH组和PIVH组中，14 d内死亡患者血浆FDP水平均显著高于存活患者［ICH：2.09（1.00，5.34）μg/mL vs 1.06（0.70，1.86）μg/mL，P=0.000。PIVH：4.25（1.49，5.91）μg/mL vs 1.20（0.64，2.30）μg/mL，P=0.041］。亚组分析发现，在ICH合并IVH亚组中，14 d内死亡患者的FDP水平［2.09（1.00，5.58）μg/mL］显著高于存活者［1.26（0.90，2.21）μg/mL，P=0.027］。结论·血浆FDP>2.78 μg/mL可能预示HS患者，尤其是PIVH或ICH合并IVH患者，14 d内死亡风险较高。

关键词: 出血性脑卒中, 纤维蛋白降解产物, 预后, 脑内出血, 脑室出血

Abstract:

Objective·To investigate the value of plasma fibrin degradation product (FDP) in assessing the risk of death within 14 d after hemorrhagic stroke (HS) onset.

Methods·The general information, baseline laboratory parameters, surgical conditions and 14-day prognosis information of the patients with HS admitted to the Department of Emergency, North Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from May 1, 2017 to May 1, 2020 were retrospectively studied to analyze the factors associated with the patients' 14-day prognosis, and multivariate Logistic regression analysis was performed. The patients were then divided into intracerebral hemorrhage (ICH) group, primary intraventricular hemorrhage (PIVH) group and subarachnoid hemorrhage (SAH) group; the ICH group was divided into four subgroups, i.e., simple hematoma subgroup, ICH+intraventricular hemorrhage (IVH) subgroup, ICH+SAH subgroup, and ICH+IVH+SAH subgroup. Differences in the plasma FDP level between the patients who died and those who survived within 14 d were analysed separately for each group and subgroup.

Results·A total of 606 patients with HS were included, with an average age of (58.9 ± 15.1) years, including 405 males and 201 females. There were 493 cases in the ICH group, 32 cases in the PIVH group and 81 cases in the SAH group; in the ICH group, 254 cases were in the simple hematoma subgroup, 142 cases were in the ICH+IVH subgroup, 49 cases were in the ICH+SAH subgroup and 48 cases were in the ICH+IVH+SAH subgroup. A total of 124 patients received surgical treatment. Eighty-five patients died within 14 d of onset. The plasma FDP level [2.07 (0.92, 5.65) μg/mL] was significantly higher in the patients who died within 14 d compared with those who survived [1.12 (0.70, 2.23) μg/mL] (P=0.000), and multivariate Logistic regression analysis showed that plasma FDP>2.78 μg/mL was an independent risk factor for death within 14 d (OR=2.564, P=0.001). Group analysis revealed that the plasma FDP level of the dead patients were significantly higher than those of the surviving patients in both the ICH group [2.09 (1.00, 5.34) μg/mL vs 1.06 (0.70, 1.86) μg/mL, P=0.000] and the PIVH group [4.25 (1.49, 5.91) μg/mL vs 1.20 (0.64, 2.30) μg/mL, P=0.041]. Subgroup analysis revealed that in the ICH+IVH subgroup, the plasma FDP level of the dead patients [2.09 (1.00, 5.58) μg/mL] was significantly higher than that of the surviving ones [1.26 (0.90, 2.21) μg/mL, P = 0.027].

Conclusion·Plasma FDP>2.78 μg/mL may predict a higher risk of death within 14 d in the patients with HS, especially in those with PIVH or ICH combined with IVH.

Key words: hemorrhagic stroke (HS), fibrin degradation product (FDP), prognosis, intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH)

中图分类号:

R743.34

陈旭光, 施晟懿, 胡岚, 陈瑜, 陆一鸣, 叶静. 血浆纤维蛋白降解产物对出血性脑卒中患者早期预后的评估价值[J]. 上海交通大学学报(医学版), 2021, 41(5): 612-616.

Xu-guang CHEN, Sheng-yi SHI, Lan HU, Yu CHEN, Yi-ming LU, Jing YE. Evaluative value of plasma fibrin degradation product in early prognosis of patients with hemorrhagic stroke[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 612-616.

图/表 5

参考文献 18

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Index	Total (n=606）	Death group (n=85）	Survival group (n=521）	P value^①
Age/year	58.9±15.1	63.6±15.6	58.0±14.8	0.001
Male/n (%)	405 (66.8）	58 (68.2）	347 (66.6）	0.767
GCS score/score	11 (8，13）	7 (5，10）	12 (9，13）	0.000
SBP/mmHg^②	169±23	173±37	168±26	0.117
DBP/mmHg	96±16	98±19	96±15	0.264
Midline displacement/n (%)	127 (21.0）	49 (57.6）	78 (15.0）	0.000
Receive surgery/n (%)	124 (20.5）	27 (31.8）	97 (18.6）	0.005
Type of hemorrhage/n (%)				0.810
ICH	493 (81.4）	67 (78.8）	426 (81.8）
PIVH	32 (5.3）	5 (5.9）	27 (5.2）
SAH	81 (13.4）	13 (15.3）	68 (13.1）
FDP/(μg·mL^-1)	1.19 (0.70, 2.71）	2.07 (0.92, 5.65）	1.12 (0.70, 2.23）	0.000
Glu/(mmol·L^-1)	8.4±2.9	10.5±3.5	8.1±2.6	0.000
Ca/(mmol·L^-1)	2.3±0.1	2.3±0.1	2.3±0.1	0.951
WBC/(×10⁹·L^-1)	9.4±3.9	12.1±4.9	9.0±3.5	0.000
PLT/(×10⁹·L^-1)	193±61	196±73	192±58	0.623
INR	1.05±0.3	1.03±0.19	1.06±0.32	0.471
Cr/(μmol·L^-1)	87±56	93±55	86±56	0.404
GPT/(U·L^-1)	22±19	21±13	22±20	0.606
cTnI/(ng·mL^-1)	0.03±0.08	0.03±0.05	0.03±0.08	0.869
CRP/(mg·L^-1)	12±15	16±28	11±12	0.230

Index	Total (n=606）	Death group (n=85）	Survival group (n=521）	P value^①
Age/year	58.9±15.1	63.6±15.6	58.0±14.8	0.001
Male/n (%)	405 (66.8）	58 (68.2）	347 (66.6）	0.767
GCS score/score	11 (8，13）	7 (5，10）	12 (9，13）	0.000
SBP/mmHg^②	169±23	173±37	168±26	0.117
DBP/mmHg	96±16	98±19	96±15	0.264
Midline displacement/n (%)	127 (21.0）	49 (57.6）	78 (15.0）	0.000
Receive surgery/n (%)	124 (20.5）	27 (31.8）	97 (18.6）	0.005
Type of hemorrhage/n (%)				0.810
ICH	493 (81.4）	67 (78.8）	426 (81.8）
PIVH	32 (5.3）	5 (5.9）	27 (5.2）
SAH	81 (13.4）	13 (15.3）	68 (13.1）
FDP/(μg·mL^-1)	1.19 (0.70, 2.71）	2.07 (0.92, 5.65）	1.12 (0.70, 2.23）	0.000
Glu/(mmol·L^-1)	8.4±2.9	10.5±3.5	8.1±2.6	0.000
Ca/(mmol·L^-1)	2.3±0.1	2.3±0.1	2.3±0.1	0.951
WBC/(×10⁹·L^-1)	9.4±3.9	12.1±4.9	9.0±3.5	0.000
PLT/(×10⁹·L^-1)	193±61	196±73	192±58	0.623
INR	1.05±0.3	1.03±0.19	1.06±0.32	0.471
Cr/(μmol·L^-1)	87±56	93±55	86±56	0.404
GPT/(U·L^-1)	22±19	21±13	22±20	0.606
cTnI/(ng·mL^-1)	0.03±0.08	0.03±0.05	0.03±0.08	0.869
CRP/(mg·L^-1)	12±15	16±28	11±12	0.230

Factor	OR (95%CI)	P value
Midline displacement	3.149 (1.861?5.462)	0.000
FDP>2.78 μg·mL^-1	2.564 (1.490?4.413)	0.001
GCS score<11 score	3.779 (2.075?6.880)	0.000
Age>64 year	1.777 (1.047?3.015)	0.033
Glu>8.7 mmol·L^-1	2.140 (1.284?3.568)	0.004

Factor	OR (95%CI)	P value
Midline displacement	3.149 (1.861?5.462)	0.000
FDP>2.78 μg·mL^-1	2.564 (1.490?4.413)	0.001
GCS score<11 score	3.779 (2.075?6.880)	0.000
Age>64 year	1.777 (1.047?3.015)	0.033
Glu>8.7 mmol·L^-1	2.140 (1.284?3.568)	0.004

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