RESUMEN
Objective To explore the changes of serum visfatin and thrombus precursor protein (TpP) levels in patients with lacunar infarction,and the relationship with carotid atherosclerotic plaque ,and to determine the values of the two factors to predict lacunar infarction .Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction,including 56 cases in unstable plaque group,39 cases in stable plaque group,and another 70 healthy persons were selected as control group .Serum visfatin,high-sensitivity C reactive protein (hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography.Results The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group (t =10.886,9.180,11.889,4.990,5.084,9.703,all P <0.05).The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group were (29.10 ±8.85)μg/L,(6.15 ± 2.78)mg/L and (5.98 ±2.66) pg /mL,respectively, which were higher than those in the stable plaque group [(21.47 ±8.39)μg/L,(4.37 ±2.09)mg/L and (4.64 ±2.03)pg/mL,t =4.222,3.385,2.652,all P <0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group (t =17.342,21.770, 18.138,11.228,15.245,14.306,all P <0.05).The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group were (18.52 ±6.43)mg/L,(25.95 ±7.98)mg/L,(18.43 ±6.10)mg/L,respectively,which were higher than those in the stable plaque group [(12.40 ±5.37) mg/L,(20.81 ±8.60) mg/L, (13.86 ± 5.04)mg/L,t =3.282,2.991,3.850,all P <0.05].Conclusion The serum levels of visfatin and TpP are highly specific,can be used as important indicators for prediction and diagnosis of lacunar infarction ,and they are related to the stability of carotid atherosclerotic plaque .
RESUMEN
Objective To observe the effect of alprostadil on hemorrheological indicators of patients with multiple lacunar infarcts.Methods 146 cases with multiple lacunar infarcts were randomly divided into observation group(76 cases) and control group(70 cases) by using the method of random number table.The two groups were given conventional treatment.In addition to this,the observation group was treated with alprostadil.NIHSS was used to evaluate neurological deficits,MMSE was used to evaluate cognitive function.The indicators of hemorheology and nailfold microcirculation integral were detected,adverse drug reactions of the two groups were observed.Results After treatment,the MMSE scores of the two groups [(24.09 ±3.88)points,(22.41 ±4.06)points] were significantly higher than before treatment,the NIHSS scores [(3.67 ± 1.39) points,(4.35 ± 1.62) points] decreased significantly (t =7.241,21.095,6.017,14.179,all P ＜ 0.05).After treatment,the MMSE score of the observation group was higher than that of the control group(t =2.556,P ＜0.05),the NIHSS score of the observation group was lower than that of the control group (t =2.728,P ＜ 0.05).After treatment,the low blood viscosity,whole blood viscosity,plasma viscosity,erythrocyte sedimentation rate,erythrocyte aggregation index,erythrocyte rigidity index,platelet aggregation rate,fibrinogen of the two groups [(11.80 ± 3.65) mPa/s,(10.90 ± 2.05) mPa/s,(1.90 ± 0.48) mPa/s,(12.64 ± 3.53) mm/h,(5.05 ± 1.28),(5.74 ± 1.20),(56.92 ± 13.49) ％,(2.97 ± 0.55) g/L,(17.37 ± 3.87) mPa/s,(12.86 ±2.64) mPa/s,(2.16 ±0.58) mPa/s,(19.70 ±4.26) mm/h,(6.48 ± 1.79),(6.80 ± 1.73),(62.88 ± 13.74)％,(3.52 ± 0.64)g/L] decreased than before treatment,and erythrocyte deformation index [(0.78 ± 0.15),(0.68 ±0.12)] increased (t =24.497,15.398,16.814,24.146,14.709,8.558,10.940,46.550.11.591,10.895,13.755,13.791,6.971,5.140,4.782,4.592,9.357,all P ＜ 0.05).After treatment,the blood rheology indicators of the observation group improved more significantly than those of the control group (t =8.949,5.032,2.960,10.936,5.585,4.424,4.330,2.643,5.582,all P ＜ 0.05).After treatment,the loop shape,loop pattern,periloop state scores of the two groups [(1.14 ± 0.35) points,(1.64 ± 0.45) points,(2.07 ± 0.29) points,(1.30 ± 0.37) points,(1.85 ± 0.60) points,(2.66 ±0.38) points] decreased significantly than those before treatment (t =5.818,14.220,30.083,3.580,7.715,9.933,all P ＜ 0.05).After treatment,the loop shape,loop pattern,periloop state scores of the observation group were lower than those of the control group (t =2.685,2.404,10.595,all P ＜ 0.05).The incidence rate of adverse reaction of the observation group was 7.89％ (6/76),which of the control group was 7.14％ (5/70),the difference was not statistically significant between the two groups(x2 =0.030,P ＞ 0.05).Conclusion In the treatment of multiple lacunar infarcts,alprostadil can effectively improve hemorrheological and nailfold microcirculation integral indicators,improve the nerve defect and cognitive function of patients,the incidence rate of adverse reaction is low,it has high value in clinical application.