血浆内皮微粒水平与腔隙性脑梗死患者脑微出血的关系研究

Relationship between Plasma Endothelial Microparticle Level and Cerebral Microbleeds in Patients with Lacunar Infarction

目的探讨血浆内皮微粒(EMP)水平与腔隙性脑梗死患者脑微出血(CMB)的关系。方法选取2013年6月—2015年3月在湖北医药学院附属十堰市人民医院接受治疗的腔隙性脑梗死患者90例。比较不同临床特征的腔隙性脑梗死患者CMB发生率和血浆EMP水平,并分析腔隙性梗死患者CMB的影响因素。结果年龄≥65岁、合并高血压、合并冠心病、吸烟、低密度脂蛋白(LDL)≥3.37 mmol/L和高密度脂蛋白(HDL)<1.25 mmol/L的腔隙性脑梗死患者CMB发生率分别高于年龄<65岁、未合并高血压、未合并冠心病、不吸烟、LDL<3.37 mmol/L和HDL≥1.25 mmol/L的腔隙性脑梗死患者(P<0.05);不同性别、是否合并糖尿病、不同三酰甘油(TG)水平的腔隙性脑梗死患者CMB发生率比较,差异无统计学意义(P>0.05)。年龄≥65岁、合并高血压、合并糖尿病、合并冠心病、吸烟、LDL≥3.37 mmol/L、HDL<1.25 mmol/L及合并CMB的腔隙性脑梗死患者血浆EMP水平分别高于年龄<65岁、未合并高血压、未合并糖尿病、未合并冠心病、不吸烟、LDL<3.37 mmol/L、HDL≥1.25 mmol/L及未合并CMB的腔隙性脑梗死患者(P<0.05);不同性别、不同TG水平的腔隙性脑梗死患者血浆EMP水平比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,年龄〔OR=5.165,95% CI(1.474,18.102)〕、高血压〔OR=6.417,95%CI(2.307,17.850)〕、冠心病〔OR=3.554,95% CI(1.065,11.858)〕、吸烟〔OR=3.881,95% CI(1.202,12.528)〕和血浆EMP水平〔OR=10.859,95% CI(2.975,41.018)〕是腔隙性脑梗死患者CMB的危险因素,HDL是腔隙性脑梗死患者CMB的保护因素〔OR=0.106,95% CI(0.016,0.696)〕(P<0.05)。结论血浆EMP水平升高是腔隙性脑梗死患者CMB的危险因素,其可作为腔隙性脑梗死患者CMB的预测指标。

Objective To investigate the relationship between plasma endothelial microparticle level and cerebralmicrobleeds in patients with lacunar infarction. Methods A total of 90 patients with lacunar infarction were selected in thePeopled Hospital of Shiyan Affiliated to Hubei Medical College from June 2013 to March 2015 , incidence of cerebral microbleedsand plasma endothelial microparticle level were compared in patients with different clinical features, and the influencing factors ofcerebral microbleeds were analyzed. Results The incidence of cerebral microbleeds of lacunar infarction patients equal or over65 years old, complicated with hypertension, complicated with coronary heart disease, with smoking, with LDL equal or over3. 37 mmol/L, with HDL below 1. 25 mmol/L was statistically significantly higher than that of patients below 65 years old, didnot complicated with hypertension, did not complicated with coronary heart disease, without smoking, with LDL below 3. 37mmol/L, with HDL equal or over 1.25 mmol/L, respectively （ P 〈0 .05 ） ; while no statistically significant differences ofincidence of cerebral microbleeds was found in lacunar infarction patients with different gender, complicated with diabetes or notor with different TG （ P 〉 0.05 ） . Plasma endothelial microparticle level of lacunar infarction patients equal or over 65 years old,complicated with hypertension, complicated with diabetes, complicated with coronary heart disease, with smoking, with LDLequal or over 3. 37 mmol/L, with HDL below 1.25 mmol/L, complicated with cerebral microbleeds was statistically significantlyhigher than that of patients below 65 years old, did not complicated with hypertension, did not complicated with diabetes, didnot complicated with coronary heart disease, without smoking, with LDL below 3. 37 mmol/L, with HDL equal or over 1.25mmol/L, did not complicated with cerebral microbleeds, respectively （ P 〈0. 05） ; while no statistically significant differencesof plasma endothelial microparticle level was found in lacunar infarction patients with different gender or with different TG （ P 〉0. 05 ）. Multivariate logistic regression analysis showed that, age [ OR = 5. 165, 95% Cl （ 1. 474, 18. 102） ] , hypertensionl OR = 6. 417, 95% Cl （2 .307 , 17. 850） ] , coronary heart disease [ OR = 3. 554, 95% Cl （ 1. 065, 11. 858） ] , smoking[OR = 3. 881, 95% Cl （ 1 .202 , 12 .528 ）] and plasma endothelial microparticle level l OR = 10.859, 95% Cl （2 .975 ,41. 018 ）〕were risk factors of cerebral microbleeds in patients with lacunar infarction, while HDL [ OR = 0. 106, 95% Cl（0. 01 6,0.696） ] was the protective factor （ P 〈 0.05 ） . Conclusion Elevated plasma endothelial microparticle level is oneof the risk factors of cerebral microbleeds in patients with lacunar infarction, it plays an important role in predicting the incidenceof cerebral microbleeds in patients with lacunar infarction.