Plasma Fibrinogen And D-dimer Levels In Patients With Stroke:a Retrospective Case-control Study

Objective:To collect the clinical data of patients with stroke on admission in the third people’s Hospital of Zhangjiagang from January 2012 to April 2016,and to study the clinical characteristics,treatment and prognosis of these patients,We investigated the relationship between plasma fibrinogen and D-dimer levels in patients with different prognosis and different types of TOAST(the Trial of Org 10172 in Acute Stroke Treatment),so as to guide the prevention and treatment of stroke.Methods:The study was designed as a retrospective case-control trial.The clinical data of 854patients with stroke(ischemic stroke in 755 cases,cerebral hemorrhage in 99 cases)were collected and analyzed in different subgroups Self-care ability(modified Rankin Scale,mRS)at three months was also recorded.According to the prognosis,the patients were divided into mRS≤2 group and m RS≥3 group.We compared the baseline data and the treatment of two groups,analyzed the correlation of plasma fibrinogen,D-dimer and baseline data,and then compared different levels of fibrinogen and D-dimer distribution among the different levels of prognosis.The same analysis was performed among 755patients with ischemic stroke and 99 patients with hemorrhagic stroke.The different levels of fibrinogen and D-dimer among the different types of TOAST were also compared among the patients with ischemic stroke.Results:1)Analysis of 854 patients with stroke,the patients with better prognosis had significantly lower levels among fibrinogen,D-dimer(p<0.05).The fibrinogen levels and mRS(r=0.077,p=0.024),D-dimer levels(r=0.249,p<0.001)were positively correlated.The D-dimer levels had correlation with mRS(r=0.263,p<0.001).To compare the different levels of fibrinogen and D-dimer in different prognosis,we found that the levels of fibrinogen and D-dimer in the good prognosis group were lower than the poor prognosis group(c~2=8.75,p=0.033;c~2=8.75,p=0.033).2)755 patients with ischemic stroke were analyzed.In good prognosis groups,the levels of fibrinogen,two D-dimer ware significantly lower(p<0.05)than the poor prognosis groups.mRS was associated with the fibrinogen levels and D-dimer levels(r=0.120 p=0.001,r=0.254 p<0.001).And the D-dimer levels had correlation with fibrinogen levels(r=0.235,p<0.001).The distribution of fibrinogen and D-dimer different levels in different prognosis showed that the fibrinogen and D-dimer levels of patients with goodprognosiswerelowerthanthatinthepoorprognosis group(c~2=17.74,p=0.001;c~2=59.67,p<0.001).Comparison of different TOAST types showed that the plasma D-dimer levels were statistically different(c~2=53.303,p<0.001).Then compared with the large artery atherosclerosis and small lacunar infarction,the levels of D-dimer were significantly higher in patients with cardiogenic embolism(p<0.001).3)We analyzed 99 patients with hemorrhage stroke and found that the prognosis of patients with lower levels of D-dimer was better(p<0.05).The D-dimer levels were positively collated with fibrinogen levels(r=0.349,p<0.001)and mRS(r=0.400,p<0.001).The fibrinogen levels were no significantly different among the different prognosis(c~2=3.29,p=0.350),however,the D-dimer levels were lower in better prognosis groups(c~2=17.43,p=0.001).Conclusion:1)The levels of plasma fibrinogen and D-dimer were positively correlated with the prognosis of patients with ischmic stroke at 3 months.The lower levels of plasma fibrinogen and D-dimer,the better the prognosis of patients with cerebral infarction.2)The levels of plasma D-dimer were positively correlated with the prognosis of patients with hemorrhage stroke at 3 months.3)Fibrinogen and D-dimer were the risk factors of patients with stroke.