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目的探讨急性脑梗死患者高敏C反应蛋白和纤维蛋白原的变化与颈动脉粥样硬化超声指标之间的关系。方法应用高频多普勒超声检测颈动脉内膜—中膜厚度、斑块总计分和血流速度;同时检测其血C反应蛋白和纤维蛋白原浓度;连续观察103例,其中急性脑梗死组33例,慢性脑梗死组34例,年龄相匹配的正常对照组36例。各项数据用SPSS10软件统计分析。结果颈动脉内膜—中膜厚度和斑块发生率急性组和慢性组较对照组增加(P均<0.01),而急性组和慢性组间差异无显著性(P>0.05);慢性组颈动脉斑块积分较急性组显著增加(P>0.05);C反应蛋白浓度急性组(19.54±37.96mg/L)较慢性组(4.01±7.22mg/L)和对照组(1.66±1.17mg/L)增高(P均<0.01);慢性组较对照组增高但差异无显著性(P>0.05)。急性组、慢性组和对照组间C反应蛋白浓度95%的可信范围分别为1.24～2.08mg/L、4.52～34.56mg/L和1.42～6.62mg/L。急性组血浆纤维蛋白原浓度依次大于慢性组和对照组,但差异无显著性(P>0.05)。多元逐步回归分析表明:血C反应蛋白浓度与纤维蛋白原和斑块总计分呈正相关,与血流阻力指数呈负相关。血纤维蛋白原浓度与高密度脂蛋白胆固醇浓度呈负相关。结论脑梗死患者急性期纤维蛋白原血浓度变化不敏感;C反应蛋白血浓度升高与颈动脉内膜—中膜厚度无关,与纤维蛋白原血浓度和斑块总计分关系密切。
Objective To investigate the relationship between the changes of high sensitivity C-reactive protein and fibrinogen and the ultrasonic indexes of carotid atherosclerosis in patients with acute cerebral infarction. Methods The carotid intima-media thickness, total plaque score and blood flow velocity were detected by high-frequency Doppler ultrasound. Meanwhile, the levels of serum C-reactive protein and fibrinogen were measured. The continuous observation of 103 cases, including acute cerebral infarction group 33 cases, 34 cases of chronic cerebral infarction group, age-matched normal control group of 36 cases. The data using SPSS10 software statistical analysis. Results Carotid intima - media thickness and plaque incidence in acute group and chronic group were significantly higher than those in control group (P <0.01), but there was no significant difference between acute group and chronic group (P> 0.05) The score of arterial plaque was significantly higher than that of the acute group (P> 0.05). The levels of C-reactive protein in the acute group (19.54 ± 37.96mg / L) and the control group (4.01 ± 7.22mg / L and 1.66 ± 1.17mg / L ) (P <0.01). The chronic group was higher than the control group but the difference was not significant (P> 0.05). The plausible ranges of 95% confidence level of C-reactive protein between acute group, chronic group and control group were 1.24 ~ 2.08mg / L, 4.52 ~ 34.56mg / L and 1.42 ~ 6.62mg / L, respectively. Acute plasma fibrinogen concentration in turn than the chronic group and the control group, but no significant difference (P> 0.05). Multiple stepwise regression analysis showed that there was a positive correlation between serum C-reactive protein and total fibrinogen and plaque score, but negatively correlated with blood flow resistance index. Fibrinogen concentration and high density lipoprotein cholesterol concentrations were negatively correlated. Conclusions The changes of fibrinogen concentration in acute stage of patients with cerebral infarction are not sensitive. The elevated serum C-reactive protein has no relation with carotid arterial intima-media thickness and is closely related to the concentration of fibrinogen and the total score of plaque.