同型半胱氨酸及凝血-纤溶指标与脑小血管病的关系

Association between homocysteine, coagulation-fibrinolysis parameters and cerebral small vessel disease

目的探讨同型半胱氨酸及凝血-纤溶指标与脑小血管病(CSVD)的关系。方法纳入2019年9月至2021年9月河南省人民医院住院的CSVD患者72例(CSVD组),并招募同期头颅磁共振及神经系统查体正常者99名为对照组。检测2组研究对象血同型半胱氨酸和凝血-纤溶指标(凝血酶原时间、凝血酶原活动度、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原和D-二聚体)的水平。采用两独立样本t检验和Mann-Whitney U检验比较2组患者血同型半胱氨酸和凝血-纤溶指标的差异,采用Logistic回归分析CSVD的影响因素。结果 CSVD组同型半胱氨酸水平、纤维蛋白原和D-二聚体水平较对照组升高[12.82(11.20,18.89)μmol/L vs 10.00(8.94,12.08)μmol/L;2.88(2.59,3.38)g/L vs 2.77(2.39,3.13)g/L;0.31(0.21,0.49)μg/ml vs 0.26(0.20,0.32)μg/ml],凝血酶原活动度较对照组降低[(111.75±16.35)%vs(127.66±27.43)%],差异具有统计学意义(Z=5.324、1.980、2.128,t=4.386,P<0.001、=0.048、=0.033、<0.001)。Logistic回归分析显示,调整混杂因素后,同型半胱氨酸每升高1μmol/L,CSVD发生风险增加15%(OR=1.15,95%CI:1.05~1.25);凝血酶原活动度每升高1%,CSVD发生风险降低3%(OR=0.97,95%CI:0.95~0.99),差异均有统计学意义(P均<0.05)。结论同型半胱氨酸升高和凝血酶原活动度降低可能是CSVD的危险因素。

Objective To investigate the association between homocysteine, coagulationfibrinolysis parameters and cerebral small vessel disease(CSVD). Methods Patients with CSVD hospitalized in Henan Provincial People’s Hospital from September 2019 to September 2021 were included in the case group(n=72), and patients with normal cranial magnetic resonance and neurological examination were included in the control group(n=99). The levels of blood homocysteine and coagulation-fibrinolysis parameters(prothrombin time, prothrombin activity, activated partial thrombin time, thrombin time,fibrinogen and D-dimer) were detected. Two independent samples t-test and Mann-Whitney U test were used to compare the differences of levels in homocysteine and coagulation-fibrinolysis parameters. Logistic regression was used to analyze the risk factors of CSVD. Results In the case group, levels of homocysteine,fibrinogen and D-dimer were higher than that in the control group [12.82(11.20, 18.89) vs 10.00(8.94,12.08) μmol/L;2.88(2.59, 3.38) vs 2.77(2.39, 3.13) g/L;0.31(0.21, 0.49) vs 0.26(0.20, 0.32) μg/ml],prothrombin activity was decreased than that in the control group [(111.75±16.35)% vs(127.66±27.43)%],and the difference was statistically significant(Z=5.324, 1.980, 2.128, t=4.386;P<0.001, =0.048, =0.033,<0.001). Logistic regression analysis showed that after adjustment of confounders, the risk of CSVD increased by 15% with per 1 μmol/L increase of homocysteine(OR=1.15, 95%CI: 1.05~1.25);the risk of CSVD decreased by 3% for each 1% increase in prothrombin activity(OR=0.97, 95%CI: 0.95~0.99), and the differences were statistically significant(both P<0.05). Conclusion The increase of homocysteine and decrease of prothrombin activity may be the risk factors of CSVD.