缺血性脑血管病康复介入与纤维蛋白单体聚合功能变化的关系

背景血浆纤维蛋白原(fibrinogen,Fbg)水平的升高是脑血管病的主要危险因素,纤维蛋白单体聚合功能的评价远较Fbg水平的测定具有更重要的临床价值.目的研究缺血性脑血管病患者纤维蛋白单体聚合功能的临床意义及康复介入对其的影响作用.设计以患者和正常人为研究对象,病例-对照研究.单位一所大学医院血液病研究所和神经内科.对象2001-09/2002-03检测华中科技大学同济医学院附属协和医院神经内科110例不同类型的缺血性脑血管病患者和50例健康人.方法随机选取31例脑梗死患者进行康复介入,采用血浆纤维蛋白单位聚合功能测定系统进行测定各组血浆纤维蛋白单体聚合功能参数.主要观察指标纤维蛋白单体聚合功能各项参数的异常情况.结果缺血性脑血管病患者较健康人纤维蛋白单体聚合功能各项参数均显著增高(P＜0.01);缺血性脑血管病患者Fbg水平和纤维蛋白单体聚合速率(FMPV)的异常率较健康人显著增高(P＜0.01),纤维蛋白单体聚合功能异常患者缺血性脑血管病的相对危险度(RR)分别是健康对照组的4～31倍;脑梗死患者中,前循环梗死组FMPV较后循环梗死组和腔隙性脑梗死组显著升高(P＜0.05);康复介入前脑梗死患者纤维蛋白单体聚合功能显著高于健康对照组,康复介入后纤维蛋白单体聚合功能各参数有所降低,但与治疗前差异无显著性意义.结论纤维蛋白单体聚合功能测定能更全面、客观的反映缺血性脑血管病患者的凝血状态,能在一定程度上反应梗死的范围和严重程度.尽管一般的康复介入不能有效改善血液的高凝状态,但随着医学技术的不断发展,特殊的康复介入对于凝血机制的影响值得进一步研究.

Relationship between the rehabilitative intervention of ischemic cerebrovascular diseases and the functional alteration of monomer polymerization of fibrinogen

BACKGROUND: The elevation of plasma fibrinogen(Fbg) is a key risk factor of cerebrovascular diseases. The evaluation of the monomer polymerization function of fibrin has even more important clinical merit than the detection of Fbg level.OBJECTIVE: To investigate the clinical significance of the monomer polymerization function of fibrin in patients with isehemie cerebrovascular diseases and its impacts on rehabilitative intervention.DESIGN: A case control study employing patients and healthy individual as subjects.SETTING: An Institute of Hematology and Department of Neurology of one university.PARTICIPANTS: Totally 110 patients with different ischemic cerebrovascular disease selected from the Department of Neurology, Union Hospital of Tongji Medical College, Huazhong Science and Technology University from September 2001 to March 2002, and 50 healthy individuals were included in the study.METHODS: Rehabilitative intervention was performed in 31 randomly selected cerebral infarct patients, and the parameters indicating the monomer polymerization functions of fibrin in the plasma were detected by the measurement system for the monomer polymerization function of fibrin.MAIN OUTCOME MEASURES: Abnormal condition of monomer polymerization function of fibrin in each parameter.RESULTS: Each parameter indicating the monomer polymerization functions of fibrin in plasma was significantly increased in ischemic cerebrovascular diseases patients than healthy individuals( P ＜ 0.01 ) . The abnormal rate of Fbg leveland fibrin monomer polymerization velocity (FMPV) was significantly elevated in ischemic cerebrovascular disease patients than healthy individuals ( P ＜ 0. 01 ) . The relative risk(RR) of ischemic cerebrovascular diseases in patients with abnormal FMP functions was 4 to 31 times more than healthy control group. In cerebral infarct group, FMPV of anterior circulation infarct subgroup was significantly elevated than that of posterior circulation infarct and lacunar cerebral infarct subgroups( P ＜ 0.05). The FMP function of anterior cerebral infarct patients was significantly higher than that of healthy group before rehabilitative intervention. Although each FMP parameter reduced after rehabilitative intervention, the difference between was not significant compared with that of before therapy.CONCLUSION: FMP function analysis can completely and objectively reflect the coagulation status of the patients with ischemic cerebrovascular diseases, and it can also reflect the range and severity of infarct to some extent. Although common rehabilitative intervention cannot effectively improve the high-coagulation of the blood, the impacts of specific rehabilitative intervention on the coagulation mechanism deserve further investigation.