老年代谢综合征患者血栓前状态与脑白质疏松的相关性

Relationship between the prothrombotic state and leukoaraiosis in elderly patients with metabolic syndrome

目的探讨老年代谢综合征患者血栓前状态标志物和脑白质疏松的关系。方法采用回顾性研究方法，选取2013年1月至2015年1月于浙江大学医学院附属第一医院老年病科就诊的代谢综合征患者350例，依据头颅核磁共振结果分为脑白质疏松组203例和非脑白质疏松组147例，运用Blennow量表在核磁共振上对白质病变的分布和程度进行评分，分别检测两组患者的血浆纤维蛋白原（Fib）、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、D-二聚体、血管性血友病因子（vWF）水平，并进行比较。结果脑白质疏松组Fib、vwF、D-二聚体水平高于非脑白质疏松组（P〈0．05）。Spearman相关分析显示，脑白质疏松程度与Fib、D二聚体、vwF呈正相关（r值分别为0．014、0．089、0．215，均P〈0．05）。多元线性回归分析显示，影响老年代谢综合征患者脑白质疏松的因素依次是Fib、高血压病程、vWF、糖化血红蛋白（HbAlc），标准回归系数分别为2．516、0．312、0．206、0．167。结论高血压病程、HbAlc与脑白质疏松有关，血栓前状态检测指标中Fib、vWF可作为老年代谢综合征患者脑白质疏松程度的预测指标。

Objective To investigate the relationship leukoaraiosis（LA）in elderly patients with metabolic syndrome between the prothrombotie state and Methods A total of 350 metabolic syndrome patients in the affiliated hospital of Zhejiang University who received treatment from January 2013 to January 2015. According to the results of head MRI, patients were divided into LA group（n 203）and non-LA group（n= 147）. The severity of LA was graded by its MRI appearance and the Blennow scale. The plasma levels of fibrinogen （ Fib）, prothrombin time （ PT）, thrombin time （ TT）, activated partial blood coagulation time （APTT）, D-dirner （ D- D） and von willebrand factor （vWF） were measured and compared between the two groups. Results The levels of Fib, vWF and D-D were higher in LA group than in non-LA group（all P〈 0.05）. Spearman correlation analysis showed that the severity of leukoaraiosis was positively correlated with Fib, vWF and D-D（ r= 0.014,0. 089,0.215, respectively, all P 〈 0. 05）. Multivariate linear regression analysis showed that Fib, course of hypertension,vWF and HbAlc were the main influencing factors with the standardized regression coefficient of 2. 516,0. 312,0. 206 and 0. 167 respectively for leukoaraiosis in elderly patients with metabolic syndrome. Conclusions The course of hypertension and HbAlc level are positively related with LA. The prothrombotic state markers including Fib and vWF can be considered as the predictors for LA severity in elderly patients with metabolic syndrome.