The Clinical Research Of The Defibrase Treatment Prognosis And Secondary Prevention For Patients With Cerebral Infarction

ObjectiveUnderstand the Influence of defibrase treatment on quality of life of patients with cerebral infarction; clear fibrinogen content and the relationship between each factor; accepted understanding of defibrase in treatment of cerebral infarction patients with long-term prognosis; clear defibrase treatment in the primary prevention of cerebral infarction of two.Methods1,Using a retrospective cohort study programme, we collected the baseline information from the patients who were the first admission to Chengdu General Hospital of Kunming military command Venom diagnosis and treatment center, including gender, age, history of hypertension, diabetes mellitus, history of hyperlipidemia, atrial fibrillation, a history of heart valves, coronary heart disease, family history of stroke, smoking history,drinking history, admission NIHSS score, gcs score, coagulation indicators (PT and APTT, TT), fibrinogen (FIB), fasting glucose, triglycerides, cholesterol, and hospital treatment during the anti-platelet therapy, anticoagulation treatment, antihypertensive therapy, lipid-lowering therapy, neuroprotective, defibrase treatment, as well as defibrase dose, the final diagnosis (ischemic stroke, hemorrhagic stroke, and other non-stroke diagnosis). And baseline data were divided into defibrase treatment group and non-defibrase treatment group in according to the defibrase treatment or not. 2,By telephone follow-up, clinic service follow-up,et al,we follow up the patients who meet the inclusion criteria, the main follow-up content include that patients died or not, the cause of death, relapse, relapsing forms,secondary prevention forms including antiplatelet therapy, antihypertensive therapy, anticoagulationtherapy, lipid-lowering therapy, Chinese medicine treatment, and patients survival do mRS score.3,Using SPSS17.0statistical software for data analysis, measurement data between the two groups, if you obey normal distribution, using t test; if the normal distribution, using the Kruskal-Wallis test; count data in groups of two or more, using the chi-square test. Multiple factor analysis of the multivariate linear regression analysis and Binary Logistic regression analysis.Results1,we collected588cases and504people pass the follow-up, follow-up rate is85.7percent, down fiber group and baseline data for non-drop fiber group comparison results is that The non-drop fiber group have more patients in the coronary heart disease history,the atrial fibrillation history, the heart valves history, and the secondary prevention of anticoagulant therapy.Because P<0.05, the difference was statistically significant, The non-drop fiber group have the majority of coronary heart disease history,have more Atrial fibrillation PatientGender, age, history of hypertension, diabetes mellitus, smoking history, drinking history, admission NIHSS score, fibrinogen, triglycerides, cholesterol, during hospitalization antiplatelet, anticoagulant, thrombolytic therapy, antihypertensive, hypoglycemic,lipid-lowering, and neuroprotective treatment, secondary prevention, antiplatelet, blood pressure lowering, hypoglycemic, lipid-lowering, P>0.05, the difference was not statistically different.2,Using stepwise regression (stepwise) to have a multiple linear regression test, age, risk factors and drinking history, admission GCS score and the NIHSS score, PT, hemorheology index, cholesterol and other indicators in the regression equationpartial regression coefficient test is meaningless, in the regression equation was removed. Results into the equation since the variable is of APTT, TT, an mRS, triglycerides, smoking and sex. Looking from the partial regression coefficient, mRS (B=0.173), triglycerides (B=0.167), gender (B=0.383), smoking (B=.459) and fibrinogen are Positive correlationand APTT (B=-0.027), TT (B=-0.047), negative correlation with fibrinogen. Look from the standardized regression coefficients we indicate that the TT (B=-0.222) have the most influence on the fibrinogen.3,Analysis the risk factors of disabilities using logistic regression, the results show that, the more NIHSS score, the higher risk of disability (OR1.302,95%CI1.200-1.412), the higher fibrinogen levels, the higher risk of disability (OR1.455,95%CI1.143-1.852); men patients have less disability risk than female patients (OR0.538,95%CI0.291-0.996), The patients with Defibrase treatment have less disability risk than those with non-defibrase-treatment(OR0.187,95%CI,0.093-0.374), those patients with secondary prevention lipid-lowering therapy have less disability risk than those with not(OR0.533,95%CI,0.287-0.991).4,Analysis the risk factors of recurrence using logistic regression, the older the recurrence greater the risk (OR1.042,95%CI0.999-1.086), with diabetes, coronary heart disease in patients with relapsed high risk (OR16.316,95%CI1.388-191.800; OR3.628,95%CI), in patients with a history of smoking relapse risk higher (OR3.194,95%CI1.277,-7.983), higher fibrinogen levelsthe higher the risk of relapse (OR1.034,0.977-1.094); during hospitalization is not neuroprotective treatment, secondary prevention is not hypoglycemic patients with high risk of relapse (OR0.341,95%CI0.108-1.081), defibrasethe lower the dose the higher the risk of recurrence in patients (OR0.865,95%CI,0.830-0.902).5,Defibrase treatment group and non defibrase treatment group recurrence rates were compared using chi-square test, defibrase group recurrence rate was10.48%, non defibrase group a recurrence rate of57.14%, x2=102.162, P=0<0.05, the difference was statistically significant.Defibrase treatment group and non defibrase treatment group mortality compared using chi-square test, x2=13.429, P=0<0.05, defibrase group mortality was7.38%, non defibrase group mortality was20.24%, the difference was statistically significant. Kaplan-Meier survival analysis revealed the defibrase group and Defibrase group survival curves showed no significant difference (P=0.227).Conclusion1,mRS score and triglyceride levels, gender factors, APTT and TT is the impact factors of fibrinogen; an mRS score high fibrinogen levels, high triglyceride content of high fibrinogen levels, male patients with fibrinogenhigh levels of smokers fibrinogen levels and low fibrinogen levels for the elderly; activated partial thromboplastin time (APTT), prothrombin time (TT), elderly low fibrinogen levels. The standardized regression coefficients showed that the TT content of fibrinogen.2,admission NIHSS score, fibrinogen, OR (EXP (B)) values are>1, indicating that factors independent risk factor for disability, gender, fiber-lowering treatment, secondary prevention lipid-lowering OR values<1, indicating thatdisability risk in men than women small, fiber-lowering therapy than patients with small, secondary prevention lipid-lowering treatment of disability risk defibrase disability risk than not two prevention lipid-lowering in patients with disability risk is small.3,History of diabetes, smoking history, history of coronary heart disease are independent predictors of stroke recurrence defibrase dosage, blood sugar control is to reduce an independent predictor of stroke recurrence risk.4,Defibrase treatment did not reduce the risk of death in patients with cerebral infarction,there are no significant correlation between Death and defibrase treatment.