缺血性脑血管疾病患者血浆纤维蛋白原水平与颈动脉粥样硬化

目的 探讨缺血性脑血管疾病(ICVD)患者血浆纤维蛋白原(Fg)水平与颈动脉粥样硬化(CAS)的关系及各危险因素对CAS发生发展的作用.方法 选择ICVD患者840例,包括脑梗死、短暂性脑缺血发作(TIA)和椎-基底动脉供血不足(VBI).应用彩色多普勒超声检查患者颈总动脉、颈内动脉颅外段及分叉处内-中膜厚度(IMT).评定标准:IMT≤0.9 mm为正常,0.9 mm1.5 mm为斑块形成,管腔狭窄≥30%为狭窄.同时检测血浆Fg及其他生化指标,记录高血压、糖尿病、高脂血症、吸烟、饮酒等疾病史,测量血压,运用逻辑回归分析相关危险因素对CAS的作用大小.结果 脑梗死组血浆Fg水平最高[(3.91 ±1.05)g/L],与TIA组[(3.45±0.81)g/L]间差异有统计学意义(X2=62.812,P<0.01),其CAS发生率(77.0%)也最高,与TIA组(61.8%)间差异有统计学意义(X2=9.000,P<0.01).按Fg四分位数分等级(<3.16 g/L、3.16～3.72 g/L、3.73～4.39 g/L和>4.39 g/L),Ordinal逻辑回归分析显示随着Fg值的升高,发生CAS的危险度逐渐加大(4个等级内OR值分别为1.00、1.80、3.36和3.38).颈动脉正常组与不同CAS组间的年龄、Fg、收缩压、血糖、性别、糖尿病史及高血压病史差异均有统计学意义.多元逻辑回归分析显示仅年龄、收缩压和Fg对CAS的影响有统计学意义,其中Fg对CAS的作用最强.结论 Fg升高与ICVD患者CAS的形成及发展密切相关,其作用可能强于其他传统危险因素.

Relationship between plasma level of fibrinogen and carotid atherosclerosis in the patients with ischemic cerebrovascular disease

Objective To investigate the association between the plasma level of fibrinogen and carotid atherosclerosis(CAS)in patients with ischemic cerebrevascddar disease(ICVD),and the effects intensity of different risk factors on CAS.Methods Carotid intima-media thickness(IMT)was measured by color Doppler uhrasonography in 840 patients with ICVD,including cerebral infarction(ci),transient ischemic attack and insufficient blood-supply of vertebral-basilar artery.According to the results of uhrasonography,the patients were divided into four groups:normal(IMT≤0.9 mm),arterial sclerosis (0.9 mm1.5 mm)and stenosis(stenosis of lumina≥30%).The plasma fibrinogen and other biochemical markers were also detected.The history of hypertension,diabetes,hyperlipemia,smoking,drinking were recorded,and the blood pressure was measured.Results The level of fibrinogen was the highest((3.91±1.05)g/L)in the patients with CI,the difference was significant compared to the patients with TIA((3.45±0.81)S/L,X2=62.812,P<0.01),and so was the prevalence of CAS(77.0%),there was significant difference compared to the patients with TIA(61.8%,X2=9.000,P<0.01).The rate of CAS increased gradually with the quartiles of the fibrinogen(the odds ratios in the 2nd,3rd and 4th quartiles(3.16-3.72 g/L,3.72-4.39 g/L and>4.39 g/L)were 1.80,3.36 and 3.38 respectively,all P≤0.01).There were significant differences of age,fibrinogen,systolic blood pressure,hyperglycaemia and history of diabetes and hypertension between the normal-carotid group and three CAS groups.Multiple logistic regression showed that only the age,fibrinogen and systolic blood pressure significandy influenced on the CAS with the highest risk factor being the fibrinogen.Conclusions In the patients with ICVD,the elevated plasma fibrinogen Was significantly correlated with CAS,and misht play more important role than other traditional risk factors.