von Willebrand因子和凝血因子Ⅷ 水平与急性脑梗死的临床转归  

von Willebrand Factor and Factor Ⅷ are Associated with Prognosis of Acute Ischemic Stroke

作　　者：陈新悦[1] 毕国荣[1] 李双[2] 赵丹丹[1] 

机构地区：[1]中国医科大学附属盛京医院神经内科,沈阳110000 [2]阜新市中心医院神经内科

出　　处：《中国神经精神疾病杂志》2016年第1期22-28,共7页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探索急性脑梗死患者血浆FVIII（factor VIII,FVIII）和VWF（von Willebrand factor,VWF）水平的升高与疾病的严重性、预后、住院期间发生感染或神经功能损伤加重等事件的关系。方法在2014年12月至2015年3月期间就诊于中国医科大学附属盛京医院神经内科的住院患者中,筛选出急性脑梗死病例组90例,无急性脑梗死的对照组50例,测定血浆FVIII和VWF水平。按两因子水平是否升高将病例组分成4组：FVIII和VWF均不升高组（FVIII-/VWF-）、FVIII升高且VWF不升高组（FVIII↑/VWF-）、FVIII不升高且VWF升高组（FVIII-/VWF↑）和FVIII和VWF均升高组（FVIII↑/VWF↑）。比较各病例组和对照组的临床特点。结果病例组的VWF水平的中位数1521.88 U/L,明显高于对照组的中位数1281.77 U/L（P=0.023）。与FVIII-/VWF-组相比,FVIII↑/VWF↑组急性脑梗死的发病症状较重（入院NIHSS评分〉5分）（OR=3.643,95%CI：1.258-10.549,P=0.017）,疾病预后较差（3个月m RS评分〉2分）（OR=7,95%CI：2.304-21.266,P=0.001）,出院时m RS评分〉2分者所占比例高（OR=3.797,95%CI：1.346-10.713,P=0.012）,住院期间更易发生神经功能损伤加重（OR=5.538,95%CI：1.099-27.908,P=0.038）,且更易并发感染（OR=3.913,95%CI：1.115-13.729,P=0.033）。对各种混杂因素进行校正后,发现FVIII和VWF水平同时升高是急性脑梗死患者预后不良的独立预测因素（OR=4.495,95%CI：1.012-19.957,P=0.048）。结论急性脑梗死患者很可能存在FVIII或VWF水平升高,二者水平同时升高可能对疾病的严重性及临床转归有影响,并且很可能是预后不良的独立预测因素。ObjectiveThe purpose of this study was to explore the effect of FVIII（factor VIII,FVIII）and VWF（von Willebrand factor,VWF）elevation on the severity, prognosis and inpatient complications such as infections and neuroworsening in patients with acute ischemic stroke.Methods Ninety patients with acute ischemic stroke and 50 patients without ischemic stroke were recruited from affiliated Shengjing hospital of China Medical University between December 2014 and March 2015. We tested FVIII and VWF levels of all the patients. Patients with acute ischemic stroke were divided into 4 groups： both FVIII and VWF within normal range（FVIII-/VWF-）; elevated FVIII, but normal VWF（FVIII↑/VWF-）; FVIII within normal range, but elevated VWF（FVIII-/VWF↑）; and elevation of both FVIII and VWF（FVIII↑/VWF↑）.Results The median of VWF was higher in the case group（1521.88 U/L） than in the control group（1281.77U/L）（P=0.023）. Compared with patients with both FVIII and VWF within normal range, patients with ele-vation of both FVIII and VWF had more severe neurological dysfunction（NIHSS at admission5）（OR=3.643,95%CI ：1.258-10.549,P=0.017）and poorer prognosis（m RS2 at the point of 3 months after stroke）（OR=7,95%CI：2.304-21.266,P=0.001）, higher proportion of m RS2 at discharge（OR=3.797,95%CI：1.346-10.713,P=0.012）,and more inpatient complications such as infections（OR=3.913,95%CI：1.115-13.729,P=0.033）and neuroworsening（OR=5.538,95%CI：1.099-27.908,P=0.038）. After additional adjustment for various confounding factors, elevation of both FVIII and VWF was an independent predictor of poor prognosis in patients with acute ischemic stroke（OR=4.495,95%CI1.012-19.957,P=0.048）.ConclusionsThe elevation of FVIII and VWF is positively associated with the severity and prognosis in patients with acute ischemic stroke, which may serve as an independent predictor of poor prognosis.

关 键 词：脑梗死 预后 von Willebrand 因子 凝血因子VIII 

分 类 号：R743.3[医药卫生—神经病学与精神病学]