重度颈动脉粥样硬化性狭窄致脑梗死患者血浆纤维蛋白原水平及其意义

目的探讨血浆纤维蛋白原在重度颈动脉粥样硬化性狭窄所致脑梗死中的意义。方法测定重度颈动脉粥样硬化性狭窄导致脑梗死患者83例（狭窄梗死组）、无症状的颈动脉狭窄患者35例（无症状狭窄组）及健康查体者50例（健康对照组）血浆纤维蛋白原含量，并分析纤维蛋白原含量与颈动脉不稳定斑块、狭窄后脑梗死类型、神经功能缺失程度及预后的关系。结果狭窄梗死组患者纤维蛋白原水平明显高于无症状狭窄组及健康对照组（309±65）g／L比（280±18）g／L、（262±25）g／L]，差异均有统计学意义（P〈0．05或P〈0．01）。区域性脑梗死患者（I型，7例）纤维蛋白原水平（421±22）g／L]明显高于皮层下梗死（Ⅱ型，16例）、白质疏松型梗死（Ⅲ型，21例）及分水岭梗死（Ⅳ型，39例）分别为（318±63）、（303±66）、（293±54）g／L]（均P〈0．05）。不稳定斑块组（45例）纤维蛋白原水平明显高于稳定斑块组（38例）（357±45）g／L比（257±41）g／L]（P〈0．05）。神经功能缺失重度组患者（9例）纤维蛋白原水平明显高于轻度（42例）、中度（32例）（412士27）g/L比（255±27）、（358±27）吕／L]，独立生活能力预后好组患者（56例）纤维蛋白原明显低于预后差组（27例）（282±55）g／L比（373±38）g／L]，差异均有统计学意义（均P〈0．01）。结论血浆纤维蛋白原水平增高与重度颈动脉狭窄及其所致脑梗死密切相关，支持特定的梗死类型，可能对病情的严重程度和预后有预示作用。

Fibrinogen level in patients with cerebral infarction caused by severe extracranial carotid stenosis

Objective To test the level of fibrinogen in patients with acute cerebral infarction caused by severe extracranial carotid artery stenosis. Methods All 83 patients with acute cerebral infarction, 35 patients with asymptomatic severe carotid artery stenosis and 50 healthy volunteers （as a control group ） were selected, the fibrinogen levels were tested to find the relativity among them and analyze the relevance with cerebral infarction type, the degree of neurologic function defect and state of stroke. Results The fibrinogen levels of the cerebral infarction group were significantly higher than those in asymptomatic severe carotid artery stenosis group and control group （309 ± 65 ） g/Lvs （ 280 ± 18 ） g/L, （ 262 ± 25 ） g/L ] （ P 〈 0.05 ） ; the fibrinogen levels of regional cerebral infarction were significantly higher than those of the control group （421 ± 22 ） g/L vs （ 318 ± 63 ）, （ 303 ± 66 ）, （293 ± 54）g/L] （all P 〈 0.05 ）. Fibrinogen levels of unstable plaque group were significantly higher than that of the stable plaque group （357 ±45）g/L vs （257 ±1 ）g/L] （P 〈0.05）. The level of fibrinogen in severe nerve function defect group were obviously higher than those in light and moderate nerve function defect group （412 ±27） g/L vs （255 ±7）, （358 ±27）g/L], and the level of fibrinogen in good prognosis group was lower than that in bad prognosis group （282± 55 ） g/L vs （373 ±38 ） g/L ], and there were significant differences （ all P 〈 0.01 ）. Conclusion The level of fibrinogen is closely related to severe carotid artery stenosis and cerebral infarction by severe carotid artery stenosis, which support specific infarction type and can indicate the severity and prognosis of the disease.