血浆纤维蛋白原水平与急性腔隙性脑梗死患者血管周围间隙扩大的关联性研究  

A study on the relationship between plasma fibrinogen level and enlarged perivascular spaces in patients with acute lacunar cerebral infarction

作　　者：邵云云 何倩倩[2] 郑雪 李敏[3] 伏兵 SHAO Yun-yun;HE Qian-qian;ZHENG Xue(Lianyungang Clinical College of Bengbu Medical College,Jiangsu 222023,China)

机构地区：[1]蚌埠医学院连云港临床学院,江苏222023 [2]连云港市第二人民医院西院区神经内科,江苏222023 [3]连云港市第二人民医院东院区康复医学科,江苏222006

出　　处：《中国临床新医学》2023年第3期242-247,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：江苏省科技厅公益科研所自主项目(编号:BM2018033-1);江苏省连云港市科技计划项目(编号:SF2142)。

摘　　要：目的探讨血浆纤维蛋白原水平与急性腔隙性脑梗死患者血管周围间隙扩大(EPVS)的关联性。方法回顾性分析2021年1月至2022年6月连云港市第二人民医院收治的伴EPVS的172例急性腔隙性脑梗死患者的临床资料。经头颅MRI评估EPVS数目及严重程度,分为基底节区血管周围间隙扩大(BG-EPVS)、半卵圆中心区血管周围间隙扩大(CSO-EPVS),轻度组(0~1级,≤10个EPVS)及中重度组(2~4级,>10个EPVS)。比较两组患者的一般临床资料,采用多因素logistic回归分析血浆纤维蛋白原水平与EPVS进展的关联性。采用ROC曲线分析血浆纤维蛋白原水平鉴别轻度、中重度EPVS的效能。结果172例患者中,判定为轻度BG-EPVS 57例(33.14%),中重度BG-EPVS 115例(66.86%);判定为轻度CSO-EPVS 100例(58.14%),中重度CSO-EPVS 72例(41.86%)。与轻度BG-EPVS组相比,中重度BG-EPVS组年龄更大,合并高血压病者更多,总胆固醇(TC)、高密度脂蛋白(HDL)、纤维蛋白原水平更高,差异均有统计学意义(P<0.05)。中重度CSO-EPVS组年龄显著大于轻度CSO-EPVS组(P<0.05),其余指标比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,年龄增加(OR=1.043)、合并高血压病(OR=2.443),以及更高水平的纤维蛋白原水平(OR=2.227)是促进BG-EPVS进展的独立危险因素(P<0.05)。ROC曲线分析结果显示,血浆纤维蛋白原水平能有效鉴别轻度与中重度BG-EPVS[AUC(95%CI)=0.693(0.611~0.775),P<0.001],最佳截断值为4.00 g/L,其对应的灵敏度为61.70%,特异度为80.70%。结论血浆纤维蛋白原水平与急性腔隙性脑梗死患者BG-EPVS的进展具有关联性,可用于鉴别诊断轻度、中重度BG-EPVS。Objective To investigate the relationship between plasma fibrinogen level and enlarged perivascular spaces(EPVS)in patients with acute lacunar cerebral infarction.Methods The clinical data of 172 acute lacunar cerebral infarction patients with EPVS who were admitted to the Second People′s Hospital of Lianyungang City from January 2021 to June 2022 were retrospectively analyzed.The number and severity of EPVS were evaluated by head magnetic resonance[JP4]imaging(MRI),which were divided into basal ganglia EPVS(BG-EPVS)and centrum semiovale EPVS(CSO-EPVS).The patients were divided into the mild group(grade 0-1:≤10 EPVS)and the moderate to severe group(grade 2-4:>10 EPVS).The general clinical data were compared between the two groups,and multivariate logistic regression was used to analyze the relationship between plasma fibrinogen level and EPVS progression.Receiver operating characteristic(ROC)[JP4]curve was used to analyze the efficacy of plasma fibrinogen level in differentiating mild from moderate to severe EPVS.Results Among the 172 patients,57 cases(33.14%)were classified as mild BG-EPVS,and 115 cases(66.86%)[LM]were classified as moderate to severe BG-EPVS.There were 100 patients(58.14%)with mild CSO-EPVS and 72 patients[JP4](41.86%)with moderate to severe CSO-EPVS.Compared with the mild BG-EPVS group,the moderate to severe BG-EPVS group was older,and had more patients with hypertension,and had higher levels of total cholesterol(TC),high-density lipoprotein(HDL)and fibrinogen,with statistically significant differences between the two groups(P<0.05).The age of the moderate to severe CSO-EPVS group was significantly older than that of the mild CSO-EPVS group(P<0.05),but there were no statistically significant differences in the other indicators between the two groups(P>0.05).The results of multivariate logistic regression analysis showed that older age(OR=1.043),complicated with hypertension(OR=2.443),[JP4]and higher fibrinogen level(OR=2.227)were independent risk factors for the progression of BG-EPVS(P<0.

关 键 词：血管周围间隙扩大 纤维蛋白原 急性腔隙性脑梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]