缺血性脑小血管病患者凝血标志物及同型半胱氨酸与血管性认知障碍的相关性

目的探讨缺血性脑小血管病(CSVD)患者凝血标志物与血管性认知障碍的相关性。方法连续入选缺血性CSVD患者300例,根据简易智能状态检查量表评分分为认知正常组106例和认知障碍组194例,认知障碍组又分为轻度组102例、中度组59例和重度组33例。选取同期门诊健康体检者60例作为对照组。测定血浆血栓调节蛋白(TM)、组织因子途径抑制物(TFPI)及同型半胱氨酸(Hcy)水平,比较各项差异。结果与对照组比较,认知正常组和认知障碍组TM及Hcy升高,TFPI降低(P<0.05);且认知障碍组较认知正常组TM及Hcy更高(32.6±30.2)μg/Lvs(21.7±14.5)μg/L,(19.3±15.2)μmo L/Lvs(14.0±6.0)μmo L/L],TFPI更低(110.3±28.2)mmol/L vs(136.8±47.9)mmol/L,P<0.05]。血浆TFPI和Hcy与患者发生认知功能障碍独立相关(P=0.000)。与轻度组比较,中度组和重度组Hcy及TM升高,TFPI降低(P<0.05);重度组较中度组变化更明显(P<0.05)。认知功能评分及不同认知域损害均与血浆TM及Hcy呈负相关,与血浆TFPI呈正相关(P<0.05,P<0.01)。结论TFPI、TM及Hcy与缺血性CSVD患者认知障碍发生、发展过程中的内皮细胞损伤有关。

Association of coagulation markers and homocysteine with vascular cognitive impairment in ischemic CSVD patients

Objective To study the assoeation of coagulation markers and Hey with vascular cognitive impairment(CI)in ischemic CSVD patients.Methods Three hundred ischemic CSVD patients admitted to our hospital were divided into CI-free group(n=106)and CI group(n=194)according to their MMSE scale score with 60 healthy persons undergoing physical examination served as a control group.The patients in CI group were further divided into mild group(n=102),moderate group(n=59)and severe group(n=33).The serum levels of TM,TFPI and Hey in different groups were measured and compared.Results The serum levels of TM and Hey were significantly higher while those of TFPI were significantly lower in CI-free group and CI group than in control group(P<0.05).That the serum levels of TFPI and Hey were independently associated vascular CI in ischemic CSVD patients.The serum levels of TM and Hey were significantly higher while those of TFPI were significantly lower in moderate and severe groups than in mild group(P<0.05)and in severe group than in moderate group(P<0.05).The cognitive scores and CI were negatively associated with the serum levels of TM and Hey and positively related with those of TPFI(P<0.05).Conclusion TFPI,TM and Hey are associated with endothelial cell injury during the occurrence and development of CI in ischemic CSVD patients.