静脉血液中D -二聚体、同型半胱氨酸、纤维蛋白原、红细胞沉降率与不同类型急性脑梗死的关系

摘要

Objective To study the relationship of plasma markers D - Dimer(DD),homocysteine(Hcy),fibrinogen(Fib),erythro-cyte sedimentation rate(ESR)in different types of acute cerebral infarction(ACI). Methods Five hundred ACI patients were divided into large artery atherosclerotic stroke(LAA)group(134 patients),small artery occlusive strike(SAO)group(160 patients),cardiogenic cerebral embol-ism(CE)group(80 patients),stroke of other demonstrated etiology(SOE)groups(45 patients)and unexplained ischemic stroke(SUE)group (81 patients)according to TOAST classification criteria from January 2014 to October 2015. Another 100 healthy examinee were enrolled as con-trol group. Plasma marker levels were detected in all subjects,and their relationship with different types of acute cerebral infarction were analyzed. Results The level of DD in CE group and level of Hcy in LAA group were significantly higher than those in the other groups. The level of FIB and ESR in LAA and CE groups were significantly higher than those in the other groups. ESR levels in SAO,SOE and SUE group were significantly higher than control group( P < 0. 05). There were remarkable correlation between DD and CE( r = 0. 147,P = 0. 046),Hcy and LAA( r =0. 185,P = 0. 004),Fib and LAA,CE( r = 0. 228,P < 0. 01;r = 0. 113,P = 0. 048)ESR and LAA,SAO,CE,SOE and SUE( r = 2. 031, P < 0. 01;r = 0. 131,P = 0. 039;r = 3. 212,P < 0. 01;r = 0. 213,P = 0. 041;r = 0. 452,P = 0. 027). Conclusion Levels of plasma mark-er showed obvious differences in different types of acute cerebral infarction,it could be used as the index to diagnosis cause of acute cerebral infarc-tion and assess the prognosis of patients.%目的：静脉血液中 D -二聚体（DD）、同型半胱氨酸（Hcy）、纤维蛋白原（Fib）、红细胞沉降率（ESR）与不同类型急性脑梗死的关系。方法以2014年1月至2015年10月接受治疗的发生急性多发脑梗死患者500例为研究对象，按照 TOAST 分型标准分为大动脉粥样硬化型（LAA）组134例、小动脉闭塞型（SAO）组160例、心源性脑栓塞型（CE）组80例、其他明确病因型（SOE）组45例、不明病因型（SUE）组81例。另选同期健康体检者100例为对照组。检测所有受试者静脉血液中 DD、Hcy、Fib、ESR 水平，并分析它们与不同类型急性脑梗死的关系。结果 CE 组 DD 水平和LAA 组 Hcy 水平均明显高于其他各组，LAA 组和 CE 组的 Fib 水平和 ESR 水平均明显高于其他各组，SAO 组、SOE 组和SUE 组 ESR 水平均明显高于对照组（ P 均＜0.05）。血浆标志物 DD 水平与 CE 相关（ r =0.147，P =0.046），Hcy 水平与 LAA 相关（ r =0.185，P =0.004），Fib 水平与 LAA、CE 均存在密切相关（ r =0.228，P ＜0.01；r =0.113，P =0.048），ESR 水平与 LAA、SAO、CE、SOE 及 SUE 均相关（ r =2.031，P ＜0.01；r =0.131，P =0.039；r =3.212，P ＜0.01；r =0.213，P =0.041；r =0.452，P =0.027）。结论不同类型的急性脑梗死，静脉血液中 DD、Hcy、Fib、ESR 水平存在明显的差异，可作为急性脑梗死病因的判断和评估患者预后的指标。