摘要目的 探讨皮质下缺血性血管病(SIVD)患者血小板聚集功能(PA)的变化及其意义.方法 选取2015年10月至2017年7月在安徽医科大学第一附属医院神经内科住院的SIVD患者108例,健康对照30名为该院同期健康体检正常人群.根据头颅MRI将SIVD组分为多发性腔隙性脑梗死(LI)组(n=31)、脑白质疏松(LA)组(n=77),同时按照Fazekas的评分标准将LA组严重程度分为3级.所有受试者分别以花生四烯酸(ACA)、二磷酸腺苷(ADP)和胶原(COLL)为诱导剂,采用光学比浊法测定血小板的最大聚集率.比较SIVD组及各亚组与健康对照组(NC组)间PA水平的变化,并分析PA水平与LA程度的相关性.结果 SIVD组PA水平均显著高于NC组,差异具有统计学意义(P<0.001).LA组和LI组PA水平均显著高于NC组,差异具有统计学意义(P<0.001),LA与LI组PA水平差异无统计学意义(P>0.05).COLL诱导的PA水平LA3级与LA1级组间差异有统计学意义(P=0.026).相关分析显示年龄及PA水平与LA等级均存在显著正相关(r=0.380,P=0.001;r=0.260,P=0.026).在校正各血管危险因素后多元回归分析显示,ACA、ADP及COLL分别诱导的 PA 高水平组(>86.80%, >87.63%, >87.60%)及较高水平组(82.63% ~86.80%, 82.80%~87.63%,83.80%~87.60%)发生SIVD的风险高于一般水平组(<82.63%,<82.80%,<83.80%),发病风险分别是其13.95、20.78、28.53及3.09、5.85、9.02倍,差异均有统计学意义(P<0.001,P=0.038;P<0.001,P=0.003;P<0.001,P=0.002).结论 PA的增强可能是SIVD的独立危险因素,PA水平与LA严重程度存在密切相关,该研究对进一步了解SIVD的发病机制,并为临床上SIVD的防治提供部分理论依据.

abstractsObjective To explore the change and value of platelet aggregability(PA)in patients with subcortical ischemic vascular disease(SIVD).Methods A total of 108 patients with SIVD hospitalized in the Department of Neurology of the First Affiliated Hospital of Anhui Medical University from October 2015 to July 2017 were enrolled as SIVD group and 30 healthy cases were also in cluded as normal controlgroup(NC).According to magnetic resonance imaging(MRI), the SIVD group was further divided into two subtypes:lacunar infarction(LI)(n=31)and leukoaraiosis(LA)(n=77).The severity of LA was further graded according to the Fazekas scale.The maximum aggregation rate of platelets was measured by optical turbidimetry, respectively, using four arachidonic acid(ACA), two adenosine monophosphate (ADP)and collagen(COLL)as inducerin all subjects.The change of PA between the subtypes of SIVD and NC were compared,and the relationship between PA and the severity of LA was analyzed.Results The level of PA in SIVD was significantly higher than those in NC(P<0.001).In comparison with NC,the level of PA was significantly higher in both LI and LA subgroups(P<0.05).Meanwhile, there was no significant difference between LA group and LI group(P>0.05).Moreover, between LA groups, the PA induced by COLL were significantly different between the LA 3 group and the LA1 group(P=0.026). Correlation analysis showed that ageand the level of PA induced by COLL was positively correlated with LA grade(r=0.382,P=0.001;r=0.260,P=0.026).Multivariate logistic regression analysis revealed that after controlling for various factors,when induced by ACA,the risk of SIVD in the highest group(>86.80%)and higher group(82.63%-86.80%)was 13.95 and 3.09 times respectively higher than in the normal group(<82.63%), the differences were statistically significant(P<0.001, P=0.038); when induced by ADP,the risk of SIVD in the highest group(>87.63%)and higher group(82.80% -87.63%)was 20.78 and 5.85 times respectively higher than in the normal group(<82.80%), the differences were statistically significant(P<0.001,P=0.003);When induced by COLL,the risk of SIVD in the highest group(>87.60%)and higher group(83.80% -87.60%)was 28.53 and 9.02 times respectively higher than in the normal group(<83.80%), the differences were statistically significant (P<0.001, P=0.002).Conclusions The increasedlevel of PA is an independent risk factor of SIVD and closely related with the severity of LA.This study provides a theoretical basis for further understanding of the SIVD′s pathogenesis and for the prevention and treatment of SIVD in the clinical practice.