MTHFR基因多态性及Fib、PAI-1与脑梗死患者下肢深静脉血栓的相关性研究  

Relationship between MTHFR gene polymorphism,Fib,PAI-1 and deep venous thrombosis of lower extremity in patients with cerebral infarction

作　　者：黄秀萍 张建军 胡常晖 靳志雄 Huang Xiuping;Zhang Jianjun;Hu Changhui(Department of Emergency,Zhangjiakou First Hospital,Zhangjiakou 07500,China)

机构地区：[1]张家口市第一医院急诊科,075000 [2]张家口市第一医院肾内科,075000 [3]张家口市第一医院普外科,075000

出　　处：《中华保健医学杂志》2023年第5期500-503,共4页Chinese Journal of Health Care and Medicine

基　　金：河北省医学科学研究课题计划项目(20232074)。

摘　　要：目的探讨亚甲基四氢叶酸还原酶(MTHFR)基因多态性及纤维蛋白原(Fib)、纤溶酶原激活抑制物-1(PAI-1)与脑梗死患者下肢深静脉血栓(LDVT)的相关性。方法回顾性分析2020年1月~2022年12月在张家口市第一医院接受治疗的脑梗死患者100例。依据入院14 d后超声检查结果分为LDVT组(n=27)与无LDVT组(n=73)。比较两组基线资料信息、MTHFR基因多态性以及实验室相关指标,通过ROC分析入院时美国国立卫生研究所脑卒中量表(NIHSS)评分、Fib、PAI-1预测脑梗死患者LDVT的价值。采用多因素logistic回归分析脑梗死患者LDVT的危险因素。结果100例脑梗死患者行超声检测,发现27例(27.00%)发生LDVT,其中股静脉血栓8例(29.63%),胫前静脉血栓6例(22.22%),胫后静脉血栓4例(14.81%),腘静脉血栓4例(14.81%),腓肠肌肌间静脉血栓5例(18.52%);73例(73.00%)脑梗死患者无LDVT。LDVT组房颤、MTHFR基因多态性为CT、TT人数占比以及入院时NIHSS评分、Fib、PAI-1水平高于无LDVT组,差异有统计学意义(P<0.05);经ROC分析证实入院时NIHSS评分、Fib、PAI-1均可预测脑梗死患者LDVT,曲线下面积分别为0.795、0.763、0.801(P<0.05);多因素logistic回归分析证实,房颤、入院时NIHSS评分≥14.810分、MTHFR基因多态性为CC和CT、Fib≥3.800 g L以及PAI-1≥41.005 ng L是脑梗死患者LDVT的危险因素(P<0.05)。结论MTHFR基因多态性及Fib,PAI-1与脑梗死患者LDVT的发生密切相关,房颤、入院时NIHSS评分≥14.810分、MTHFR基因多态性为CC和CT、Fib≥3.800 g L以及PAI-1≥41.005 ng L是脑梗死患者LDVT的危险因素,临床应对符合以上因素的患者进行重点筛查,尽早采取干预措施,改善患者预后。Objective To explore the correlation between methylenetetrahydrofolate reductase(MTHFR)gene polymorphism,fibrinogen(Fib),plasminogen activator inhibitor-1(PAI-1),and lower limb deep venous thrombosis(LDVT)in patients with cerebral infarction.Methods The clinical data of 100 patients with cerebral infarction who received treatment in Zhangjiakou First Hospital from January 2020 to December 2022 were retrospectively analyzed.According to the ultrasonic examination result 14 days after admission,the patients were divided into LDVT group and no LDVT group.Baseline data,MTHFR gene polymorphism and laboratory related indicators were compared between the two groups.The value of NIHSS score,Fib and PAI-1 in predicting LDVT in patients with cerebral infarction was analyzed by ROC.Multiple logistic regression was used to analyze the risk factors of LDVT in cerebral infarction patients.Results Among 100 patients with cerebral infarction,27 cases(27.00%)were found to have LDVT,including 8 cases of femoral vein thrombosis(29.63%),6 cases of anterior tibial vein thrombosis(22.22%),4 cases of posterior tibial vein thrombosis(14.81%),4 cases of popliteal vein thrombosis(14.81%),and 5 cases gastrocnemius intermuscular vein thrombosis(18.52%).73 patients(73.00%)with cerebral infarction had no LDVT.The polymorphisms of atrial fibrillation and MTHFR gene in LDVT group were higher than those in no LDVT group(P<0.05),including the proportion of CT and TT patients and the levels of NIHSS score,Fib and PAI-1 at admission.The ROC analysis confirmed that the NIHSS score,Fib,and PAI-1 at admission can predict LDVT in cerebral infarction patients,with areas under the curve of 0.795,0.763 and 0.801,respectively(P<0.05).Multifactor logistic regression analysis revealed that atrial fibrillation,NIHSS score≥14.810,MTHFR gene polymorphism(CC and CT),Fib≥3.800 g L,and PAI-1≥41.005 ng L were risk factors for LDVT in cerebral infarction patients(P<0.05).Conclusion MTHFR gene polymorphism,Fib and PAI-1 are closely related to the occurrence of

关 键 词：亚甲基四氢叶酸还原酶 纤维蛋白原 纤溶酶原激活抑制物-1 脑梗死 下肢深静脉血栓 

分 类 号：R74[医药卫生—神经病学与精神病学]