缺血性脑小血管病患者脂蛋白a、纤维蛋白原和D-二聚体与血管性认知障碍的相关性  

Association of lipoprotein a, fibrinogen and D-dimer with vascular cognitive impairment in patients with ischemic cerebral small vessel diseases

作　　者：崔颖 刘斌 董亚楠 费云瀚 王雅楠 Cui Ying;Liu Bin;Dong Yanan;Fei Yunhan;Wang Yanan(First Department of Neurology,the Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院神经内一科,唐山063000

出　　处：《中华行为医学与脑科学杂志》2019年第4期331-336,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：河北省医学适用技术跟踪项目(G2018062);中国煤炭工业协会科学技术研究指导性计划项目(MTKJ2017-336);河北省政府资助临床医学优秀人才培养和基础课题研究项目(361036).

摘　　要：目的探讨缺血性脑小血管病患者脂蛋白a(Lipoprotein a,Lpa)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)与血管性认知障碍的相关性。方法连续入选华北理工大学附属医院神经内科住院治疗的缺血性脑小血管病患者300例作为研究对象,选取同期门诊健康体检者70人作为对照组。采用简易精神状况检查表(mini mental state examination,MMSE)评定认知功能。根据MMSE评分结果将缺血性脑小血管病患者分为认知正常组(106例)和认知障碍组(194例),其中认知障碍组进一步分为轻度认知障碍组(100例)、中度认知障碍组(60例)和重度认知障碍组(34例)。采用乳胶免疫比浊法检测Lpa水平、凝固法检测FIB水平、酶联免疫荧光法检测D-D水平,比较分析各项结果。结果(1)与对照组[Lpa:(101.67±37.37)mg/L,FIB:(3.02±0.67) g/L,D-D:(231.49±95.00)mg/L]比较,认知正常组[Lpa:(150.58±89.55) mg/L,FIB:(3.48±0.80) g/L,D-D:(287.79±125.25) mg/L]、认知障碍组[Lpa:(257.98±189.23) mg/L ,FIB:(3.86±0.97)g/L,D-D:(347.23±120.69) mg/L] Lpa,FIB和D-D水平升高,差异有统计学意义(均P<0.01);与认知功能正常组比较,认知障碍组的Lpa、FIB和D-D水平升高,差异有统计学意义(均P<0.01)。(2)与轻度认知障碍组[Lpa:(169.08±51.63) mg/L,FIB:(3.10±0.69) g/L,D-D:(288.91±92.58) mg/L]比较,中度认知障碍组[Lpa:(236.78±107.15 )mg/L ,FIB:(3.52±0.67 g/L),D-D:(345.03±132.68 )mg/L]、重度认知障碍组[Lpa:(292.65±108.19 )mg/L,FIB:(4.04±1.08) g/L,D-D:(401.58±84.87) mg/L]水平升高,差异有统计学意义(均P<0.01);与中度认知障碍组比较,重度认知障碍组Lpa、FIB和D-D水平升高,差异有统计学意义(均P<0.01)。(3)以缺血性脑小血管病患者是否患有认知障碍为状态变量拟合ROC曲线,Lpa的ROC曲线下面积为0.706,P<0.01,95%CI为(0.646~0.766);FIB的ROC曲线下面积为0.613,P=0.001,95%CI为(0.548~0.679);D-D的ROC曲线下面积为0.670,P<0.01,95%CI为(0.604~0.736)。(4)Lpa、FIB、D-D与�Objective To explore the correlation between lipoprotein a (Lpa), fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD). Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology, Affiliated Hospital of North China University of Science and Technology were selected as the research objects, and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination(MMSE). According to the results of MMSE, patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (100 cases), moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases). Lpa level was detected by latex immunoturbidimetry, FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed. Results (1) Compared with the control group (Lpa:(101.67±37.37)mg/L, FIB:(3.02±0.67) g/L, D-D:(231.49±95.00) mg/L), the levels of Lpa, FIB and D-D in normal group(Lpa:(150.58±89.55) mg/L, FIB:(3.48±0.80) g/L, D-D:(287.79±125.25)mg/L)and cognitive impairment group(Lpa:(257.98±189.23)mg/L , FIB:(3.86±0.97) g/L, D-D:(347.23±120.69) mg/L)increased significantly (all P<0.01). Compared with the cognitive normal group, the levels of Lpa, FIB and D-D in cognitive impairment group increased significantly (all P<0.01).(2) Compared with mild cognitive impairment group (Lpa: 169.08±51.63 mg/L, FIB:(3.10±0.69)g/L, D-D:(288.91±92.58)mg/L), the levels of Lpa, FIB and D-D of in moderate cognitive impairment group (Lpa:(236.78±107.15) mg/L, FIB:(3.52±0.67) g/L, D-D:(345.03±132.68) mg/L), severe cognitive impairment group (Lpa:(292.65±108.19) mg/L, FIB:(4.04±1.08) g/L, D-D:(401.58±84.87) mg/L) increased significantly (all P<0.01). Compared with the moderate cognitive impai

关 键 词：缺血性脑小血管病 血管性认知障碍 脂蛋白A 纤维蛋白原 D-二聚体 

分 类 号：R743[医药卫生—神经病学与精神病学]