Kohriyama T, Yamaguchi S, Tanaka E, Yamamura Y, Nakamura S
Third Department of Internal Medicine, Hiroshima University School of Medicine.
Rinsho Shinkeigaku. 1996 May;36(5):640-7.
We correlated coagulation and fibrinolytic parameters with small-vessel disease revealed by magnetic resonance imaging (MRI) of the brain. One hundred and eleven patients with asymptomatic or symptomatic cerebral infarction were randomly selected for the study; 57 males and 54 females with an average age of 66.6 +/- 9.6, age range 40 to 85, years old. Among them, 76 patients had a history of symptomatic cerebral infarction; 38 patients hypertension; and 24 patients diabetes mellitus. Patients with large cortical infarction, cerebral hemorrhage, demyelinating disease or mass lesions were excluded from the present study. The MRI scans were reviewed for areas with increased signal intensity on T2-weighted images. The small infarction was defined as a lesion less than 10mm in diameter. The activity of von Willebrand factor (vWF) correlated significantly with the grade of caps at the anterior and posterior horns of the lateral ventricle, and the number of small infarctions in the subcortical white matter and basal ganglia, suggesting vWF could be a predictor for these small-vessel disease. The grade of caps at posterior horn of the lateral ventricle and the number of small infarctions in the subcortical white matter were associated significantly with the concentration of plasma fibrinogen and reversely with the activity of antithrombin III, an inhibitory factor in coagulation system. These results indicate that hypercoagulable state may causatively relate with small-vessel disease in the territory of medullary artery branching from cortical artery. On the contrary, these coagulation parameters did not correlate significantly with small ischemic lesions in the territory of perforating artery. No correlation was observed between the level of marker proteins for platelet activation and the degree of small-vessel disease, indicating the activation of platelet could not associate with the etiology of small-vessel disease.
我们将凝血和纤溶参数与脑部磁共振成像（MRI）显示的小血管疾病进行了关联研究。随机选取111例无症状或有症状的脑梗死患者进行研究；其中男性57例，女性54例，平均年龄66.6±9.6岁，年龄范围40至85岁。其中，76例有症状性脑梗死病史；38例有高血压；24例有糖尿病。本研究排除了有大面积皮质梗死、脑出血、脱髓鞘疾病或占位性病变的患者。对MRI扫描结果进行回顾，观察T2加权图像上信号强度增加的区域。小梗死定义为直径小于10mm的病变。血管性血友病因子（vWF）的活性与侧脑室前后角帽的分级以及皮质下白质和基底节中小梗死灶的数量显著相关，提示vWF可能是这些小血管疾病的一个预测指标。侧脑室后角帽的分级以及皮质下白质中小梗死灶的数量与血浆纤维蛋白原浓度显著相关，与凝血系统中的抑制因子抗凝血酶III的活性呈负相关。这些结果表明，高凝状态可能与皮质动脉分支的髓质动脉区域的小血管疾病有因果关系。相反，这些凝血参数与穿通动脉区域的小缺血性病变无显著相关性。未观察到血小板活化标记蛋白水平与小血管疾病程度之间的相关性，表明血小板活化与小血管疾病的病因无关。
