急性脑梗死伴颈动脉斑块患者同型半胱氨酸、D-二聚体和纤维蛋白原的变化

目的：探讨老年急性脑梗死（ACI）伴颈动脉粥样硬化（CAS）斑块患者的血浆同型半胱氨酸（Hcy）、D-二聚体及纤维蛋白原的变化规律及临床意义。方法100例确诊的老年ACI患者均接受颈动脉彩色多普勒超声检查，测量左右颈总动脉内-中膜厚度（IMT），根据结果分组为有CAS斑块组（n=60）和无CAS斑块组（n=40）。分别采用循环酶法、免疫比浊法及Clauss法检测血浆Hcy、D-二聚体和纤维蛋白原浓度并记录。将2组的血浆Hcy、D-二聚体及纤维蛋白原浓度进行比较，分析它们的变化规律和意义。结果老年ACI患者有CAS斑块组血浆Hcy浓度[17.77（13.00～23.10）μmol/L]高于无CAS斑块组[12.64（9.88～15.85）μmol/L]；D-二聚体浓度[237.68（157.00～354.25）μg/L]高于无CAS斑块组[169.48（115.25～250.00）μg/L]；纤维蛋白原浓度[2.89（2.50～3.92）g/L]高于无CAS斑块组[2.58（2.23～3.48）g/L]，差异均有统计学意义（P＜0.05）。结论血浆Hcy、D-二聚体及纤维蛋白原水平增高与老年ACI患者的CAS斑块的形成关系密切，临床应早期干预治疗。

The Variation of Homocysteine,D-Dimer and Fibrinogen in Elderly Patients with Acute Cerebral Infarction and Carotid Atherosclerotic Plaque

ObjectiveTo investigate the change and clinical signifi cance of homocysteine （Hcy）, D-dimer andfi brinogen in elderly patients with acute cerebral infarction （ACI） and carotid atherosclerotic （CAS） plaque. Methods 100 definite ACI elderly patients received the colour Doppler ultrasonograph to detect the intima-media thickness （IMT） of bilateral carotid arteries. Then, the patients were divided into group with CAS plaque （60 cases） and group without CAS plaque （40 cases） according to the result of the detection. All the patients were measured the concentration of plasma Hcy, D-dimer,fi brinogen by enzymatic cycling assay, immunoturbidimetry and Clauss. The change and clinical signifi cance of homocysteine, D-dimer andfi brinogen in elderly patients with ACI and carotid atherosclerotic plaque underwent statistical analysis.Results The concentration of plasma Hcy in the group with CAS plaque （17.77[13.00~23.10]μmol/L） was higher than that in the group without CAS plaque （12.64[9.88~15.85]μmol/L）. The concentration of D-dimer andfi brinogen in the group with CAS plaque （237.68[157.00~354.25]μg/L）, （2.89[2.50~3.92]g/L） were also higher than that in the group without CAS plaque （169.48[115.25~250.00]μg/L）, （2.58[2.23~3.48]g/L）. The date reaches statistic signifi cance （P〈0.05）. Conclusion The formation of CAS plaque may be closely associated with the increased level of plasma Hcy, 〈br〉 D-dimer andfi brinogen in the elderly patients with ACI. It would be useful to clinical prediction and treatment at early stage.