von Willebrand因子和凝血因子Ⅷ 水平与急性脑梗死的临床转归

发布时间：2018-01-31 05:01

本文关键词： 脑梗死预后 von Willebrand 因子凝血因子VIII　出处：《中国神经精神疾病杂志》2016年01期 　论文类型：期刊论文

【摘要】：目的探索急性脑梗死患者血浆FVIII(factor VIII,FVIII)和VWF(von Willebrand factor,VWF)水平的升高与疾病的严重性、预后、住院期间发生感染或神经功能损伤加重等事件的关系。方法在2014年12月至2015年3月期间就诊于中国医科大学附属盛京医院神经内科的住院患者中,筛选出急性脑梗死病例组90例,无急性脑梗死的对照组50例,测定血浆FVIII和VWF水平。按两因子水平是否升高将病例组分成4组:FVIII和VWF均不升高组(FVIII-/VWF-)、FVIII升高且VWF不升高组(FVIII↑/VWF-)、FVIII不升高且VWF升高组(FVIII-/VWF↑)和FVIII和VWF均升高组(FVIII↑/VWF↑)。比较各病例组和对照组的临床特点。结果病例组的VWF水平的中位数1521.88 U/L,明显高于对照组的中位数1281.77 U/L(P=0.023)。与FVIII-/VWF-组相比,FVIII↑/VWF↑组急性脑梗死的发病症状较重(入院NIHSS评分5分)(OR=3.643,95%CI:1.258~10.549,P=0.017),疾病预后较差(3个月m RS评分2分)(OR=7,95%CI:2.304~21.266,P=0.001),出院时m RS评分2分者所占比例高(OR=3.797,95%CI:1.346~10.713,P=0.012),住院期间更易发生神经功能损伤加重(OR=5.538,95%CI:1.099~27.908,P=0.038),且更易并发感染(OR=3.913,95%CI:1.115~13.729,P=0.033)。对各种混杂因素进行校正后,发现FVIII和VWF水平同时升高是急性脑梗死患者预后不良的独立预测因素(OR=4.495,95%CI:1.012~19.957,P=0.048)。结论急性脑梗死患者很可能存在FVIII或VWF水平升高,二者水平同时升高可能对疾病的严重性及临床转归有影响,并且很可能是预后不良的独立预测因素。
[Abstract]:Objective to explore the plasma of patients with acute cerebral infarction (factor VIII, FVIII FVIII) and VWF (von Willebrand factor, VWF) elevated levels of severity and the prognosis of the disease, the relationship between infection or nerve injury aggravated events during hospitalization. Patients in the period from December 2014 to March 2015 in China Medical University Hospital Affiliated Shengjing Hospital of Neurology screening of acute cerebral infarction, 90 cases of acute cerebral infarction, the control group of 50 cases, the determination of plasma FVIII and VWF levels. According to the two factor level is increased the patients were divided into 4 groups: FVIII and VWF were not elevated group (FVIII-/VWF-), FVIII and VWF increased (FVIII = /VWF-) group, FVIII not increasing and VWF group increased (FVIII-/VWF = FVIII and VWF) and increased group (FVIII = /VWF =). The cases and controls the clinical features. Results the median level of 1521.8 cases of VWF 8 U/L, the median was significantly higher than the control group 1281.77 U/L (P=0.023). Compared with group FVIII-/VWF-, FVIII = /VWF = the onset of symptoms of acute cerebral infarction group (heavy admission NIHSS score of 5) (OR=3.643,95%CI:1.258~10.549, P=0.017), disease prognosis is poor (3 months m RS score 2 points) (OR=7,95%CI:2.304~21.266, P=0.001) at the time of discharge, m RS score 2 high proportion (OR=3.797,95%CI:1.346~10.713, P=0.012), during the period of hospitalization are more susceptible to nerve function injury (OR=5.538,95%CI:1.099~27.908, P=0.038), and more susceptible to infection (OR=3.913,95%CI:1.115~13.729, P=0.033). For the correction of various confounding factors, found that FVIII and VWF are independent predictors of increased level at the same time the poor prognosis of patients with acute cerebral infarction (OR=4.495,95%CI:1.012~19.957, P=0.048). Conclusion patients with acute cerebral infarction may have elevated FVIII or VWF level, the two level at the same time The increase may have an impact on the severity of the disease and clinical outcomes, and may be an independent predictor of poor prognosis.

【作者单位】：中国医科大学附属盛京医院神经内科;阜新市中心医院神经内科;
【分类号】：R743.3
【正文快照】： 急性脑梗死的发病存在不同的病理机制,其临床转归受包括凝血过程在内的很多病理生理过程影响。凝血因子VIII(factor VIII,FVIII)在凝血过程中发挥关键作用,它与von Willebrand因子(vonWillebrand factor,VWF)形成复合物以维持性质的稳定,二者共同介导血小板的聚集和粘附[1-2]

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