| 摘要: |
| 目的 比较新型冠状病毒感染（COVID-19）与非COVID-19的急性缺血性脑卒中患者的临床特点、炎症指标及凝血功能，探讨COVID-19后发生急性缺血性脑卒中的危险因素。方法 采用单中心回顾性研究设计，纳入2022年11月5日至2023年2月5日于我院接受治疗且完善COVID-19病毒核酸检测的急性缺血性脑卒中患者187例，其中COVID-19患者75例（COVID-19组）、未发生COVID-19患者112例（非COVID-19组）。分析两组患者的一般临床资料、炎症和凝血功能指标，包括中性粒细胞/淋巴细胞比值（NLR）、D-二聚体、纤维蛋白原（FIB）等。采用多因素logistic回归模型分析COVID-19后发生急性缺血性脑卒中的独立危险因素。结果 COVID-19组的NLR[3.62（2.31，6.71） vs 2.64（1.87，5.04），P=0.014]、D-二聚体[0.70（0.32，2.27）mg/L vs 0.37（0.27，0.76）mg/L，P=0.001]、FIB[4.21（3.26，5.17）g/L vs 3.25（2.77，3.87）g/L，P<0.001]高于非COVID-19组，淋巴细胞计数[1.40（1.03，1.71）×109/L vs 1.61（1.09，2.21）×109/L，P<0.05]低于非COVID-19组。多因素logistic回归分析结果表明，既往脑卒中史（OR=5.430，95%CI 1.538~19.175，P=0.009）、D-二聚体（OR=1.425，95%CI 1.104~1.840，P=0.007）及FIB（OR=2.405，95%CI 1.683~3.437，P<0.001）是COVID-19后发生急性缺血性脑卒中的独立危险因素。结论 COVID-19后急性缺血性卒中患者的炎症和凝血功能的血清生物标志物NLR、D-二聚体、FIB水平升高。COVID-19后缺血性脑卒中的发病与高凝状态相关。 |
| 关键词: 新型冠状病毒感染 急性缺血性脑卒中 中性粒细胞/淋巴细胞比值 D-二聚体 纤维蛋白原 |
| DOI：10.16781/j.CN31-2187/R.20230162 |
| 投稿时间：2023-03-31修订日期：2023-06-25 |
| 基金项目: |
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| Changes of coagulation function are associated with acute ischemic stroke after coronavirus disease 2019 |
| HUYAN Meihua△,CHEN Lei△,YUAN Hui,YANG Jie,JIANG Yi,WU Tao,DENG Benqiang,ZHANG Yongwei* |
(Neurovascular Center, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To compare the clinical characteristics, inflammatory indexes and coagulation function of patients with acute ischemic stroke complicated with coronavirus disease 2019 (COVID-19) and those without COVID-19, and to explore the risk factors of acute ischemic stroke after COVID-19. Methods A single-center retrospective study was conducted in 187 patients with acute ischemic stroke who were treated in our hospital from Nov. 5, 2022 to Feb. 5, 2023 and were tested for COVID-19, including 75 patients with COVID-19 (COVID-19 group) and 112 patients without COVID-19 (non-COVID-19 group). The general clinical data, inflammation and coagulation function indexes (neutrophil-lymphocyte ratio[NLR], D-dimer, and fibrinogen[FIB]) of the 2 groups were analyzed. Multivariate logistic regression was used to analyze the independent risk factors of acute ischemic stroke after COVID-19 infection. Results NLR (3.62[2.31, 6.71] vs 2.64[1.87, 5.04], P=0.014), D-dimer (0.70[0.32, 2.27] mg/L vs 0.37[0.27, 0.76] mg/L, P=0.001) and FIB (4.21[3.26, 5.17] g/L vs 3.25[2.77, 3.87] g/L, P<0.001) of COVID-19 group were markedly higher than those of non-COVID-19 group, and lymphocyte count (1.40[1.03, 1.71]×109/L vs 1.61[1.09, 2.21]×109/L, P<0.05) was lower than that of non-COVID-19 group. Multivariate logistic regression analysis showed that the previous stroke history (odds ratio[OR]=5.430, 95% confidence interval[CI]1.538-19.175, P=0.009), D-dimer (OR=1.425, 95% CI 1.104-1.840, P=0.007) and FIB (OR=2.405, 95% CI 1.683-3.437, P<0.001) were independent risk factors for acute ischemic stroke after COVID-19. Conclusion Serum biomarkers of inflammation and coagulation function (NLR, D-dimer, and FIB) are increasesd in patients with acute ischemic stroke after COVID-19, and the incidence of ischemic stroke after COVID-19 is related to hypercoagulability. |
| Key words: coronavirus disease 2019 acute ischemic stroke neutrophil-lymphocyte ratio D-dimer fibrinogen |
