Swartz J E, Jacobson B F, Connor M D, Bernstein P L, Fritz V U
Division of Neurology, Department of Neurosciences, University of the Witwatersrand, Johannesburg.
S Afr Med J. 2005 Aug;95(8):607-12.
Systemic infection and inflammation have been implicated in the aetiology of thrombotic cerebral events, particularly in younger patients. We decided to determine whether those patients with raised D-dimer levels, indicating continuing thrombosis and fibrinolysis, had evidence of concurrent infection or inflammation as manifested by a raised erythrocyte sedimentation rate (ESR) measured after an ischaemic stroke/transient ischaemic attack (TIA).
One hundred and forty-eight patients who had suffered either single or recurrent cerebrovascular episodes were analysed. The patients were referred to the thrombosis and haemostasis unit at Johannesburg Hospital for evaluation of their thrombotic profiles, including D-dimer levels. Concurrent infection was assessed by measurement of white cell count (WCC) and ESR. The variable time interval between the date of the most recent cerebrovascular event and the date of venesection was determined. A history was taken, a physical and neurological examination was performed, and a cardiology assessment and neuroimaging studies were done.
Raised D-dimer levels correlated significantly with ESR levels (p = 0.0094) in all patients. This was particularly evident when comparing the 70 younger patients (aged less than 45 years) with the 78 older patients (> 45 years) with raised D-dimers (p = 0.0070). When analysing other markers of inflammation/infection in association with raised D-dimer levels and ESR, mean fibrinogen levels were significantly raised at 6.56 g/l (p = 0.0122). An elevated WCC, as a categorical variable, was significantly associated with an elevated ESR (p = 0.0092).
There is a significant correlation between elevated D-dimer levels (indicating abnormalities of coagulation and fibrinolysis) and markers of inflammatory and/or infective processes. This is particularly evident in black patients below the age of 45 years. These patients are believed to be at decreased risk for generalised atheromatous disease compared with older white patients. The ramifications of these findings are potentially important with regard to thrombotic cerebrovascular disease aetiology, investigation, management and prevention.
全身感染和炎症被认为与血栓性脑事件的病因有关，尤其是在年轻患者中。我们决定确定那些D - 二聚体水平升高（表明持续血栓形成和纤维蛋白溶解）的患者是否有并发感染或炎症的证据，这可通过缺血性中风/短暂性脑缺血发作（TIA）后测得的红细胞沉降率（ESR）升高来体现。
对148例曾发生单次或复发性脑血管事件的患者进行分析。这些患者被转诊至约翰内斯堡医院的血栓形成与止血科，以评估他们的血栓形成情况，包括D - 二聚体水平。通过测量白细胞计数（WCC）和ESR评估并发感染情况。确定最近一次脑血管事件日期与静脉采血日期之间的可变时间间隔。进行病史采集、体格和神经系统检查，并进行心脏评估和神经影像学研究。
在所有患者中，D - 二聚体水平升高与ESR水平显著相关（p = 0.0094）。当比较70例年轻患者（年龄小于45岁）和78例D - 二聚体水平升高的老年患者（> 45岁）时，这一点尤为明显（p = 0.0070）。在分析与D - 二聚体水平升高和ESR相关的其他炎症/感染标志物时，平均纤维蛋白原水平显著升高至6.56 g/l（p = 0.0122）。作为分类变量，WCC升高与ESR升高显著相关（p = 0.0092）。
D - 二聚体水平升高（表明凝血和纤维蛋白溶解异常）与炎症和/或感染过程的标志物之间存在显著相关性。这在45岁以下的黑人患者中尤为明显。与老年白人患者相比，这些患者被认为患全身性动脉粥样硬化疾病的风险较低。这些发现对于血栓性脑血管疾病的病因、调查、管理和预防可能具有重要意义。
