Study On The Relationship Between Fibrinogen,Lipoprotein(a) And Recurrence Of Large Artery Atherosclerotic Cerebral Infarction

ObjectivesBy detecting plasma fibrinogen(FIB)and lipoprotein(a)[Lp(a)]levels in patients with large artery atherosclerotic(LAA)cerebral infarction,To explore the correlation between plasma FIB and Lp(a)levels and LAA cerebral infarction recurrence,To provide a basis for the secondary prevention of LAA cerebral infarction.MethodsA total of 296 patients with LAA cerebral infarction who were admitted to the First Affiliated Hospital of Dali University from September 2020 to December 2021 and met the inclusion criteria were selected as the study objects.All the enrolled patients were followed up by telephone and divided into recurrent group and non-recurrent group according to whether they had new cerebral infarction.The general data,blood indexes,cervical vascular color ultrasound and head imaging examination of all patients were collected and statistically analyzed.Spearman test was used to analyze the correlation,Logistic regression analysis was used to analyze the risk factors of recurrent LAA cerebral infarction,and the receiver operator characteristic(ROC)was used to evaluate the predictive value of FIB,Lp(a)and the combination of the two in predicting the recurrence of LAA cerebral infarction.Results1.Follow-up of 296 patients with LAA cerebral infarction showed that 60 patients(20.27%)had recurrence within one year,and 236 patients(79.73%)had no recurrence.Among them,there were 36 cases(23.07%)of male patients and 24 cases(17.14%)of female patients with recurrence,with no statistical significance(P>0.05).2.Comparing the general data of recurrent group and non-recurrent group,it was found that the NIHSS score of admission was high,and unstable patches,large cerebral infarction volume,non-compliance with medical advice,lack of exercise and abnormal sleep time were higher in recurrent group of LAA cerebral infarction,with statistical difference(P<0.05).3.Comparing the blood indexes of patients with recurrence and non-recurrence groups,it was found that the levels of plasma Total cholesterol(TC),Homocysteine(HCY)and White Blood Cell count(WBC)in patients with recurrence group were significantly higher than those in patients with non-recurrence group,and the level of plasma High density lipoprotein(HDL)was lower than that in patients with non-recurrence group,with statistical significance(P<0.05).4.Comparing the levels of plasma FIB and Lp(a)in patients with recurrent group and non-recurrent group,the levels of plasma FIB and Lp(a)in patients with recurrent group were significantly higher than those in patients with non-recurrent group,and the difference was statistically significant(P<0.05).5.Correlation analysis:①The correlation analysis between FIB,Lp(a)and recurrence of LAA cerebral infarction showed that the level of plasma FIB was positively correlated with the recurrence of LAA cerebral infarction(P<0.05),the correlation coefficient was 0.336,and the level of plasma Lp(a)was positively correlated with the recurrence of LAA cerebral infarction(P<0.05),the correlation coefficient was 0.362.②The correlation analysis between FIB,Lp(a)and other blood test indexes showed that there was a positive correlation between plasma FIB and TC(r=0.286),a positive correlation between plasma Lp(a)and WBC(r=-0.581),and a negative correlation(r=-0.581)between LP(a)and HDL.6.Multivariate Logistic regression analysis showed that unstable plaque,failure to comply with doctor’s advice and elevated plasma levels of Lp(a),HCY,FIB and WBC were risk factors for recurrence of LAA cerebral infarction within one year.7.The predictive value of FIB,Lp(a)and their combination in predicting the recurrence of LAA cerebral infarction was analyzed by ROC curve.The results showed that the area under the curve of FIB was 0.719(95%CI:0.644-0.794),the Jordan index was 0.379,the best critical value was 4.09,the sensitivity was 65.0%,and the specificity was 12.9%.The area under the curve of Lp(a)was 0.760(95%CI:0.6888-0.832),the Yoden index was 0.379,the optimal critical value was 46.75,the sensitivity was 65.0%,and the specificity was 83.1%.The combined area under the curve was 0.842(95%CI:0.7888-0.896),the Yoden index was 0.536,the sensitivity was 66.7%,and the specificity was 86.9%.Conclusion1.The risk of recurrence of LAA cerebral infarction is higher within one year.2.FIB and Lp(a)are associated with the recurrence of LAA cerebral infarction,and the higher the plasma levels of FIB and Lp(a),the greater the risk of recurrent LAA cerebral infarction.3.FIB is positively correlated with TC,plasma FIB level may be affected by TC,Lp(a)is positively correlated with WBC and negatively correlated with HDL,and plasma Lp(a)level may be affected by WBC and HDL.4.Unstable plaque,failure to comply with doctor’s advice and high plasma levels of FIB,Lp(a),HCY and WBC may be risk factors for recurrent cerebral infarction.5.The levels of Lp(a)and FIB may have potential predictive value for the recurrence of LAA cerebral infarction,and the combination of the two may have higher predictive value.