颈动脉狭窄患者中纤维蛋白降解物与脑梗死的相关性分析  

Correlation analysis between fibrin degradation and cerebral infarction in patients with carotid artery stenosis

作　　者：王诗颖 孙羽东 韩同磊 杨静[2] 景在平 赵志青 WANG Shi-ying;SUN Yu-dong;HAN Tong-lei;YANG Jing;JING Zai-ping;ZHAO Zhi-qing(Department of Vascular Surgery,Changhai hospital Affiliated to Naval Medical University,Shanghai 200433,China;Deparment of General Surgery,Shanghai Seventh People's Hospital,Shanghai 200137,China)

机构地区：[1]海军军医大学附属长海医院血管外科,上海200433 [2]上海市第七人民医院普外科,上海200137

出　　处：《中国血管外科杂志（电子版）》2019年第4期262-265,共4页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金面上项目（81770482）;上海市卫计委科研课题青年项目（20184Y0313）;浦东新区卫生系统特色专病建设资助项目（PWZ262017-13）

摘　　要：目的探索伴有糖尿病的颈动脉狭窄患者纤维蛋白降解物(fibrin degradation,FDP)与术前脑梗死发生风险的相关性。方法选取2017年至2018年于上海长海医院治疗的颈动脉狭窄患者183例,按照术前有无脑梗死的发生分成脑梗死组(71例)和无症状组(112例)。术前记录患者相关病史并且检测凝血、肝肾功、血常规等实验室检查指标,分析与术前脑梗死发生相关的危险因素。结果在调整了年龄、肾功能不全病史、吸烟史、D-二聚体等变量后发现,颈动脉狭窄合并糖尿病的患者中FDP每增加1μg/ml,脑梗死发生风险降低39%(OR=0.61,95%CI=0.38~0.99,P<0.05)。在无糖尿病的颈动脉狭窄患者中通过曲线拟合发现,以FDP=4.64μg/ml为截点,FDP与脑梗死发生存在显著差异。当FDP<4.64μg/ml时,每增加1μg/ml,脑梗死发生风险增加59%(OR=1.59,95%CI=1.07~2.37,P<0.05);当FDP>4.64μg/ml时,每增加1μg/ml,脑梗死发生风险降低86%(OR=0.14,95%CI=0.02~1.15,P=0.067),但差异无统计学意义。结论在颈动脉狭窄合并存在糖尿病的患者中,FDP是术前脑梗死发生的保护因素,对筛查预测术前脑梗死有一定的临床意义。在无糖尿病的颈动脉狭窄患者中,FDP越接近4.64μg/ml,发生脑梗死的风险越高,具有一定的警示作用。Objective To explore the correlation between fibrin degradation(FDP)and the risk of preoperative cerebral infarction in patients with carotid artery stenosis with diabetes mellitus.Methods 183 patients with carotid artery stenosis treated in Changhai hospital from 2017 to 2018 were selected and divided into cerebral infarction group(n=71)and asymptomatic group(n=112)according to the occurrence of cerebral infarction before surgery.Preoperative medical history of the patient was recorded and laboratory examination indicators such as coagulation,liver and kidney function and blood routine were detected.Risk factors related to the occurrence of preoperative cerebral infarction were analyzed.Results After adjusting for age,history of renal insufficiency,smoking,and D-dimer,the risk of cerebral infarction decreased by 39%for every 1μg/ml increase in FDP(OR=0.61,95%CI=0.38~0.99,P<0.05).In patients with carotid stenosis without diabetes,the risk of cerebral infarction increased by 59%for every 1μg/ml increase in FDP when FDP was less than 4.64μg/ml(OR=1.59,95%CI=1.07~2.37,P<0.05).When FDP was greater than 4.64μg/ml,the risk of cerebral infarction decreased by 86%for every 1μg/ml increase in FDP(OR=0.14,95%CI=0.02~1.15,P=0.067),however,the difference was not statistically significant.Conclusion FDP is a protective factor for preoperative cerebral infarction in patients with carotid artery stenosis complicated with diabetes,which is of great clinical significance for future screening and prediction of preoperative cerebral infarction.In patients with carotid artery stenosis without diabetes,the closer FDP is to the fold point value of 4.64μg/ml,the higher the risk of cerebral infarction,which has a certain warning effect.

关 键 词：颈动脉狭窄 脑梗死 糖尿病 纤维蛋白降解物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]