Wada Manabu, Takahashi Yoshimi, Iseki Chifumi, Kawanami Toru, Daimon Makoto, Kato Takeo
Department of Neurology, Faculty of Medicine, Yamagata University, Japan.
Intern Med. 2011;50(9):999-1007. doi: 10.2169/internalmedicine.50.4752. Epub 2011 May 1.
Recent studies suggest that hemostatic and endothelial factors play a pivotal role in the development of cerebral small vessel disease (SVD). Although plasma fibrinogen is an essential factor in the coagulation cascade, the relationship among fibrinogen, cognitive function, and SVD has not been clarified in community-based Asian populations. Because fibrinogen levels of Asians have been reported to be lower than these of Caucasians, the impact of fibrinogen on the development of SVD or dementia in Asians may be different from that of Caucasians.
We performed a cross-sectional study using MRI to determine the relationships among fibrinogen, cognitive function, and subclinical SVD in community-based Japanese elderly.
Subjects with raised fibrinogen levels tended to have more lacunes and higher grades of white matter lesions (WMLs). Additionally, an independent association between fibrinogen and WMLs was determined by logistic regression analyses. Subjects with high fibrinogen levels accompanied by high von Willebrand factors or thrombomodulin levels had an increased tendency for the presence of WMLs. The relationship between the mean Mini-Mental State Examination (MMSE) scores and the quartiles of fibrinogen levels was not statistically significant after controlling for age, gender, and WMLs; however, the mean MMSE scores in subjects without WML were related to the tertiles of the fibrinogen levels even after adjusting for conventional risks and high sensitivity C-reactive protein.
The present study suggests that there is a close relationship between fibrinogen levels and subclinical WMLs, which are independent of conventional risk factors and inflammation, in community-based Japanese elderly.
近期研究表明，止血和内皮因子在脑小血管病（SVD）的发展中起关键作用。虽然血浆纤维蛋白原是凝血级联反应中的一个重要因子，但在以社区为基础的亚洲人群中，纤维蛋白原、认知功能和SVD之间的关系尚未阐明。由于据报道亚洲人的纤维蛋白原水平低于白种人，纤维蛋白原对亚洲人SVD或痴呆发展的影响可能与白种人不同。
我们进行了一项横断面研究，使用磁共振成像（MRI）来确定以社区为基础的日本老年人中纤维蛋白原、认知功能和亚临床SVD之间的关系。
纤维蛋白原水平升高的受试者往往有更多的腔隙和更高等级的白质病变（WMLs）。此外，通过逻辑回归分析确定了纤维蛋白原与WMLs之间的独立关联。纤维蛋白原水平高且伴有血管性血友病因子或血栓调节蛋白水平高的受试者出现WMLs的倾向增加。在控制年龄、性别和WMLs后，简易精神状态检查表（MMSE）平均得分与纤维蛋白原水平四分位数之间的关系无统计学意义；然而，即使在调整了传统风险因素和高敏C反应蛋白后，无WML受试者的MMSE平均得分仍与纤维蛋白原水平三分位数相关。
本研究表明，在以社区为基础的日本老年人中，纤维蛋白原水平与亚临床WMLs之间存在密切关系，且这种关系独立于传统风险因素和炎症。
