Wei Chen-Chen, Zhang Shu-Ting, Liu Jun-Feng, Lin Jing, Yang Ting-Ting, Zhang Shi-Hong, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
J Stroke Cerebrovasc Dis. 2017 Nov;26(11):2630-2637. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.027. Epub 2017 Aug 16.
Leukoaraiosis (LA), a surrogate of cerebral small-vessel diseases (CSVD), has been increasingly recognized because of its high prevalence and strong prognostic value in stroke. But the mechanism of LA is incompletely clarified. Fibrinogen is a crucial role in coagulation cascade and inflammation. There are inconsistent reports on the association of fibrinogen with LA in the general population. We aimed to investigate the association between fibrinogen and LA in patients with stroke and atrial fibrillation (AF), which was not ever reported before.
Patients with ischemic stroke and AF were prospectively and consecutively recruited. Clinico-demographic data and fibrinogen levels were collected within 48 hours from stroke onsets and analyzed according to the presence and distribution of LA (periventricular hyperintensity [PVH] and deep white matter hyperintensity).
Of 186 patients (34.4% male; mean age, 68.76 ± 12.76 years) enrolled, 134 patients (72.0%) presented with LA. Elevated fibrinogen levels were associated with higher presence of LA (P = .005) and PVH (P = .002). After adjustment for the confounders, the fibrinogen levels were independently correlated with LA and PVH (all P <.05). Patients with elevated fibrinogen levels (≥3.5 g/L) were more likely to present with LA and PVH, with the odds ratios of 14.037 (95% confidence interval [CI] 2.588-76.131) and 12.567 (95% CI 2.572-61.395), respectively.
This study found that fibrinogen was independently and positively associated with LA and PVH in patients with stroke and AF. These results provide further evidence for the key role of fibrinogen in LA, even the total CSVD burden.
脑白质疏松（LA）是脑小血管病（CSVD）的一个替代指标，因其在卒中中的高患病率和强大的预后价值而越来越受到认可。但LA的发病机制尚未完全阐明。纤维蛋白原在凝血级联反应和炎症中起关键作用。关于一般人群中纤维蛋白原与LA的关联，报道并不一致。我们旨在研究纤维蛋白原与既往未报道过的卒中合并心房颤动（AF）患者的LA之间的关联。
前瞻性连续纳入缺血性卒中和AF患者。在卒中发作后48小时内收集临床人口统计学数据和纤维蛋白原水平，并根据LA（脑室周围高信号[PVH]和深部白质高信号）的存在和分布进行分析。
纳入的186例患者（男性占34.4%；平均年龄68.76±12.76岁）中，134例（72.0%）出现LA。纤维蛋白原水平升高与LA的更高发生率（P = 0.005）和PVH（P = 0.002）相关。在对混杂因素进行调整后，纤维蛋白原水平与LA和PVH独立相关（所有P < 0.05）。纤维蛋白原水平升高（≥3.5 g/L）的患者更有可能出现LA和PVH，比值比分别为14.037（95%置信区间[CI] 2.588 - 76.131）和12.567（95% CI 2.572 - 61.395）。
本研究发现，纤维蛋白原与卒中合并AF患者的LA和PVH独立且呈正相关。这些结果为纤维蛋白原在LA甚至整个CSVD负担中的关键作用提供了进一步证据。
