老年脑小血管病患者血浆纤维蛋白原和D-二聚体及同型半胱氨酸水平变化

Changes in fibrinogen, D-dimer and homocysteine levels in elderly patients with cerebral small vessel disease

目的探讨老年脑小血管病患者血浆纤维蛋白原（FIB）、D-二聚体、同型半胱氨酸（HCY）变化及其意义。方法前瞻性研究，连续入选2015年1月至2016年8月在蚌埠医学院第二附属医院神经内科住院的116例脑小血管病患者，进一步分为腔隙性脑梗死组50例和脑白质疏松组66例，选择同期健康老年人89例为对照组，检测各组的FIB、D-二聚体、HCY水平并进行比较和分析。结果脑小血管病组FIB、D-二聚体HCY分别为（3．3±0．9）g／L、（631．1±487．1）μg／L、（20．6±12．8）μmol／L，腔隙性脑梗死组分别为（3．3±1．0）g／L，（479．2±277．6）μg／L，（14．4±4．8）μmol／L，脑白质疏松组分别为（3．3士0．8）g／L，（750．2±577．4）μg／L，（25．4±15．0）μmol／L，均高于对照组（2．6±0．5）g／L，（202．7±81．7）μg／L，（12．8±4．6）μmol／L，差异有统计学意义（均P〈0．05）。脑小血管病多因素Logistic回归分析结果显示，FIB、D-二聚体、HCY为脑小血管病的独立相关危险因素（P〈0．01）；腔隙性脑梗死和脑白质疏松多因素回归分析结果表明，HCY与腔隙性脑梗死无相关性（P〉0．05）。结论FIB、D-二聚体、HCY可能是脑小血管病危险因素，但腔隙性脑梗死、脑白质疏松的危险因素存在差异。

Objective To examine changes infibrinogen （FIB）, D-dimer and homocysteine （HCY） levels and their significance in patients with cerebral small vessel disease （CSVD）. Methods This was a prospective study consecutively recruiting 116 patients with CSVD from January 2015 to August 2016 at the Second Affiliated Hospital of Bengbu Medical University, including 50 patients with lacunar infarction and 66 patients with leukoaraiosis. As a control group, 89 age-matched healthy elderly individuals were enrolled in the study. FIB, D-dimer and HCY levels in the groups were measured and compared. Results Serum FIB,D-dimer and HCY levels in CSVD patients,including the lacunar infarction group and the leukoaraiosis group, were all significantly higher than in the control group[（3.3±0.9 ）g/L vs. （3.31.0）g/L vs. （3.3±0.8）g/L vs. （2.6±0.5）g/L, （631. 1± 487.1）μg/L vs. （479.2±277.6） μg/L vs. （750.2±577.4） μg/L vs. （202.8±81.7）μg/L, （20.6±12.8）μmol/L vs. （14.4±4.8） μmol/L vs. （25.4±15.0） μmol/L vs. （12.8±4.6） μmol/L, all P〈 0.05）]. Multiple Logistic regression analysis showed that FIB, D-dimer and HCY were independent risk factors for CSVD （P〈0.01）. Additionally, multiple regression analysis of lacunar infarction and leukoaraiosis showed that HCY had no significant correlation with lacunar infarction （P〉 0.05）. Conclusions FIB,D-dimer,HCY may be risk factors for cerebral small vessel disease,which may not carry the same weight for lacunar infarction and leukoaraiosis.