急性脑梗死患者颈动脉硬化与C反应蛋白及纤维蛋白原的相关性

Correlation of High-Sensitivity C-Reactive Protein, Fibrinogen and Ultrasonic Index of Carotid Atherosclerosis in Patients with Acute Cerebral Infarction

目的探讨急性脑梗死患者高敏C反应蛋白和纤维蛋白原的变化与颈动脉粥样硬化超声指标之间的关系。方法应用高频多普勒超声检测颈动脉内膜—中膜厚度、斑块总计分和血流速度;同时检测其血C反应蛋白和纤维蛋白原浓度;连续观察103例,其中急性脑梗死组33例,慢性脑梗死组34例,年龄相匹配的正常对照组36例。各项数据用SPSS10软件统计分析。结果颈动脉内膜—中膜厚度和斑块发生率急性组和慢性组较对照组增加(P均<0.01),而急性组和慢性组间差异无显著性(P>0.05);慢性组颈动脉斑块积分较急性组显著增加(P>0.05);C反应蛋白浓度急性组(19.54±37.96mg/L)较慢性组(4.01±7.22mg/L)和对照组(1.66±1.17mg/L)增高(P均<0.01);慢性组较对照组增高但差异无显著性(P>0.05)。急性组、慢性组和对照组间C反应蛋白浓度95%的可信范围分别为1.24～2.08mg/L、4.52～34.56mg/L和1.42～6.62mg/L。急性组血浆纤维蛋白原浓度依次大于慢性组和对照组,但差异无显著性(P>0.05)。多元逐步回归分析表明:血C反应蛋白浓度与纤维蛋白原和斑块总计分呈正相关,与血流阻力指数呈负相关。血纤维蛋白原浓度与高密度脂蛋白胆固醇浓度呈负相关。结论脑梗死患者急性期纤维蛋白原血浓度变化不敏感;C反应蛋白血浓度升高与颈动脉内膜—中膜厚度无关,与纤维蛋白原血浓度和斑块总计分关系密切。

Aim To explore the correlation of high-sensitivity C-reative protein （hs-CRP）, fibrinogen（Fg） and the ultrasound indexes of carotid atheroselerosis in acute cerebral infarction. Methods The blood concentration of hs-CRP and Fg were tested while the carotid arteries were examined by color Dopplle and B-ultrasotmd in 103 subjects which were divided into the following groups： acute cerebral infarction group （ACI, n=33）, old cerebral infarction group （OCI, n=34）, normal controls （n=36）. Results The results showed that the carotid intimal-media thickness （IMT） were significantly increased in all of the diseased groups than those in controls（ P all〈0.01）. The total plaque score （TPS） was thicker in the group of OCI（ 8.65±5.76mm）than in the group of ACI （4.68±2.98mm）（P〈0.01） andalsoincontrol（3.71±1.35mm）（P〈0.05）. The incidence rate of atherosclerous plaque of carotid artery was higher in group of ACI （72.72%） than those in group of OCI （70.59 %）（P〈0.05） and control （16.67%） （P〈0.05）. IMT,TPS and the incidence rate of atherosclerous plaque were different between ACI group and OCI group. The serum concentration of hs-CRP in the groups of ACI （ 19.54±37.96 mg/L） was higher than that in the group of OCI （4.01±7.22 mg/L） and also in control （ 1.66±1.17 mg/L） （ all P〈0.01） ; there was no difference in the group OCI and control（P〉0.05）. The 95% confident interval of plasma hs-CRP was 1.24-2.08 mg/L;4.52-34.56mg/L; 1.42-6.62mg/LrespectivelyintheACI, OCI and control. Plasma concentration of Fg was not different in the three groups （ P〉0.05 ）. Multiple regression stepwise analysis revealed that the serum concentration of hs-CRP was positively correlated with the plasma concentration of Fg and TPS; and it was negatively correlated with resistant index. There was negative correlation between the plasma concentration of Fg and high-density hpoprotein cholesterol. Conclusions In the acute phase of cerebral infarction, the change in the plasma of Fg was not sensitive. The concentration of hs-CRP elevated was not correlated with IMT thickening, while closely correlated with the plasma Fg and the total plaque score.