【作者】 李静；

【导师】 窦志杰；

【作者基本信息】 承德医学院 ， 神经病学， 2018， 硕士

【摘要】 目的:研究血浆纤维蛋白原(Fibrinogen,FIB)、同型半胱氨酸(Homocysteine,Hcy)水平与脑小血管病(Cerebral small vessel disease,CSVD)的相关性。探讨FIB、Hcy导致CSVD的发病机制,以期为CSVD的早期诊断及干预提供理论依据。方法:连续入选承德医学院附属医院神经内科2016年1月~2017年3月住院的CSVD患者210例,其中腔隙性梗死(Lacunar infarction,LI)79例、脑白质病变(White matter lesions,WML)131例。对照组为无神经系统疾病且头颅影像学无异常改变的体检者75例。每位患者均接受头颅MRI检查,并由两名受过神经影像学培训的神经内科医师盲法单独做出诊断。依据LI的病灶数目对其严重程度进行评价,将LI患者分为单发组(1个病灶)和多发组(2个及以上病灶)。采用年龄相关的脑白质改变(Age-related White Matter Changes,ARWMC)视觉评定法将WML严重程度分为轻、中、重度。详细记录研究对象的性别、年龄、吸烟史、高血压病史、糖尿病史、血浆FIB、Hcy、影像学等临床资料。采用SPSS 19.0统计软件进行数据分析,计量资料以(x±s)表示,两组间比较采用独立样本t检验,多组间比较采用单因素方差分析;计数资料以例数和百分比(n,%)表示,两组率的比较采用χ~2检验;采用多因素有序Logistic回归分析对LI、WML的严重程度进行相关危险因素的分析;以P<0.05为差异有统计学意义。结果:1 LI组患者年龄、高血压比例、血浆FIB、Hcy水平高于对照组(P<0.05)。在LI亚组中,多发组患者高血压比例、血浆Hcy水平明显高于单发组(P<0.05)。多因素Logistic回归分析结果,显示年龄、高血压、高FIB水平、高Hcy水平为LI的独立危险因素;高血压、高Hcy水平为LI严重程度增加的独立危险因素(P<0.05)。2 WML组患者年龄、高血压比例、糖尿病比例、血浆FIB、Hcy水平高于对照组(P<0.05)。与WML轻度组相比,中度组年龄、高血压、FIB水平均显著升高,重度组年龄、高血压、FIB、Hcy水平均显著升高;与WML中度组相比,重度组Hcy水平明显升高(P<0.05)。WML严重程度的单因素方差分析结果显示,年龄、高血压、糖尿病、高水平FIB及Hcy均为WML严重程度增加的危险因素(P<0.05)。进一步对以上因素进行多因素有序多分类Logistic回归分析,结果显示,年龄、高血压、糖尿病、高水平的FIB及Hcy同样均为WML严重程度增加的危险因素(P<0.05)。结论:血浆FIB、Hcy分别为LI、WML的独立危险因素,提示FIB、Hcy的水平增高与CSVD的发生发展密切相关。Hcy的水平增高与WML、LI的严重程度呈正相关,为其病变严重程度增加的危险因素;FIB为WML严重程度增加的危险因素。LI、WML严重程度的危险因素存在差异。更多还原

【Abstract】 Objective:To investigate the relationship between plasma fibrinogen(FIB)and homocysteine(Hcy)and cerebral small vessel disease(CSVD).To explore the pathogenesis that FIB and Hcy lead to CSVD,so that theoretical basis for early diagnosis and early intervention of CSVD could be provided.Methods:Continuously selected 210 patients with CSVD from January 2016 to March 2017 in Department of Neurology,Affiliated Hospital of Chengde Medical College,including 79 cases of LI and 131 cases of WML.In the control group,there were 75 subjects who had no neurological diseases,and no abnormalities were found in the cranial imaging.Each patient underwent craniocerebral MRI examination and was independently diagnosed by two neurologists trained in neuroimaging.According to lesions number,LI patients were divided into single group(one lesion)and multiple group(two or more lesions).According to Age-Related White Matter Changes(ARWMC)scale,WML patients were divided into mild,moderate and severe.Gather the information about all people’s gender,age,history of smoking and drinking,history of hypertension and diabetes,plasma FIB,Hcy,imaging and other clinical data.All the datas were analyzed by SPSS 19.0.The measurement data was demonstrated by mean and standard deviation(x±s),the two groups were compared using independent sample t test,multiple groups were compared using one-way analysis of variance.Count data was demonstrated by the number of case and rate,the two groups were compared by theχ~2 test.The multi-factor sequential Logistic regression analysis the risk factors of LI and WML severity.When P<0.05,the difference was statistically significant.Results:1 The age,hypertension ratio,plasma FIB and Hcy levels in the LI group were higher than the control group(P<0.05).In the LI subgroup,the proportion of hypertension and plasma Hcy levels in multiple group were significantly higher than single group(P<0.05).Multivariate logistic regression analysis showed that for age,hypertension,high levels of FIB and Hcy were independent risk factors for LI.Hypertension and high levels of Hcy were independent risk factors for increased LI severity(P<0.05).2 The age,proportion of hypertension and diabetes,plasma FIB and Hcy levels in the WML group were higher than the control group(P<0.05).Compared with the WML mild group,the age,hypertension,and FIB in the moderate group were all significantly increased.The age,hypertension,FIB and Hcy in the severe group were all significantly increased(P<0.05).Compared with the moderate group,the Hcy level in the severe group was significantly higher(P<0.05).One-way ANOVA analysis of WML severity showed that age,hypertension,diabetes,high levels of FIB and Hcy were all risk factors for the increased severity of WML(P<0.05).Multi-factorial and orderly multi-category logistic regression analysis showed that age,hypertension,diabetes,high levels of FIB and Hcy were risk factors for the increased WML severity(P<0.05).Conclusion:Plasma FIB and Hcy were independent risk factors of LI and WML respectively,it is suggested that the levels of FIB and Hcy are closely related to the occurrence and development of CSVD.The level of Hcy was positively correlated with the severity of WML and LI,which suggests Hcy is the risk factor of increasing the severity of WML and LI.FIB is the risk factor of increasing the severity of WML.There are differences in risk factors for the severity of LI and WML.更多还原