慢性阻塞性肺病急性加重期并发脑梗死相关因素分析  

The Correlation Factors Analyses of COPD Complicated by CI in Acute Exacerbation Time

作　　者：孙加源[1] 丁怿虹[1] 江翠华[1] 张莹[1] 刘勤[1] 陈峥妍[1] 许宾[2] 周亚刚[2] 刘立根[2] 白春学[1] 

机构地区：[1]复旦大学附属上海市第五人民医院 [2]复旦大学附属中山医院,上海200032

出　　处：《中国临床医学》2006年第1期42-44,共3页Chinese Journal of Clinical Medicine

基　　金：上海市闵行区科技发展基金资助(04-79)

摘　　要：目的;通过分析慢性阻塞性肺病(COPD)并发脑梗死(CI)患者与单纯COPD患者血栓前状态及肺功能学指标的差异,为COPD合并CI的防治提供依据。方法:将研究对象分为COPD急性加重期并发CI组、COPD急性加重期组、急性支气管炎组,所有对象进行血气、肺动脉收缩压(PASP)、内皮素-1、心钠素、凝血酶原时间、凝血酶时间、活化部分凝血激酶时间、纤维蛋白原、抗凝血酶-Ⅲ(AT-Ⅲ)、D-二聚体(D-D)、组织纤溶酶原激活物、纤溶酶原激活物抑制物-I的检测,同时行对照研究和相关性分析。COPD急性加重期合并CI患者分析临床特征和头部CT／MRI表现。结果:COPD并发CI与单纯COPD患者比较有明显的AT-Ⅲ降低(234．39±39．66 vs 278．90±53．01,P<0．01)和D-D、PASP增加 (2．25±2．07 vs 0．87±0．61,P<0．01,42．50±17．67 vs 32．48±15．52,P<0．05),并且在COPD并发CI患者,以上3个指标存在相关性。37例COPD急性加重期合并CI患者中有心力衰竭15例,头部CT／MRI影像学表现以腔隙性脑梗死为主(37例)。结论:AT-Ⅲ、D-D、PASP可以作为诊断和预防性治疗COPD并发CI依据,在COPD人群具有上述特点者, 应早期应用抗凝治疗,控制肺动脉压力,以减少COPD并发CI。Abstract To analy the indexes differences that reflected prethrombotic states and pulmonary function between COPD （chronic obstructive pulmonary disease） and COPD complicated by CI（cerebral infarction ）, and to provide prevention and treatment evidences of COPD complicated by CI. Methods： All study subjects included COPD complicated by CI group , COPD group, acute bronehitis group. Blood gas, pulmonary arterial systolic pressure（PASP）, endothelin-1, atrial natriuretic peptide, prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen, antithrombin-Ⅲ（AT-Ⅲ）, D- dimer（D-D）, tissue plasminogen activator, plasminogen activator inhibitor-I were observed, Meanwhile,control study and correlation analyses were executed. The clinieal feature and head CT/MRI appearance also were analyzed in the COPD complicated by CI group . Results： Compared with simple COPD patients, the patients of CA3PD complicated by CI had lower AT-Ⅲ （234. 39 ± 39. 66 vs 278. 90 ± 53.01, P〈0. 01 ）, higher D-dimer and PASP（2.25 ± 2. 07 vs 0. 87 ± 0.61 , P〈0.01 ; 42. 50 ± 17.67 vs 32.48±15. 52 ,P〈0.05）. Futhermore,correlation existed among them in the group of COPD complicated by CI group. There were 15 chronic heart failure （ CHF ）patients and 37 lacunar infarction patients in COPD complicated by CI. Conclusion：AT-Ⅲ,D-D,PASP can be served as evidences for diagnosing and prophylactic treatment for patients of COPD complicated by CI. To prvent the occurrence of COPD complicated by CI,antieoagulant therapy and controling pulmonary arterial pressure should be done in time if there are features above mentioned in COPD patients.

关 键 词：慢性阻塞性肺病 脑梗死 血栓前状态 

分 类 号：R743.3[医药卫生—神经病学与精神病学]