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目的;通过分析慢性阻塞性肺病(COPD)并发脑梗死(CI)患者与单纯COPD患者血栓前状态及肺功能学指标的差异,为COPD合并CI的防治提供依据。方法:将研究对象分为COPD急性加重期并发CI组、COPD急性加重期组、急性支气管炎组,所有对象进行血气、肺动脉收缩压(PASP)、内皮素-1、心钠素、凝血酶原时间、凝血酶时间、活化部分凝血激酶时间、纤维蛋白原、抗凝血酶-Ⅲ(AT-Ⅲ)、D-二聚体(D-D)、组织纤溶酶原激活物、纤溶酶原激活物抑制物-I的检测,同时行对照研究和相关性分析。COPD急性加重期合并CI患者分析临床特征和头部CT／MRI表现。结果:COPD并发CI与单纯COPD患者比较有明显的AT-Ⅲ降低(234．39±39．66 vs 278．90±53．01,P<0．01)和D-D、PASP增加 (2．25±2．07 vs 0．87±0．61,P<0．01,42．50±17．67 vs 32．48±15．52,P<0．05),并且在COPD并发CI患者,以上3个指标存在相关性。37例COPD急性加重期合并CI患者中有心力衰竭15例,头部CT／MRI影像学表现以腔隙性脑梗死为主(37例)。结论:AT-Ⅲ、D-D、PASP可以作为诊断和预防性治疗COPD并发CI依据,在COPD人群具有上述特点者, 应早期应用抗凝治疗,控制肺动脉压力,以减少COPD并发CI。
Objective To provide basis for the prevention and treatment of COPD with CI by analyzing the difference of prethrombosis and pulmonary function between patients with chronic obstructive pulmonary disease (COPD) complicated with cerebral infarction (CI) and simple COPD. Methods: The subjects were divided into COPD acute exacerbation complicated by CI group, COPD acute exacerbation group, acute bronchitis group, all subjects were blood gas, pulmonary artery systolic pressure (PASP), endothelin-1, atrial natriuretic peptide, prothrombin Time, thrombin time, activated partial thromboplastin time, fibrinogen, antithrombin-III (AT-III), D-dimer (DD), tissue plasminogen activator, plasminogen activator Substance inhibitor-I test, at the same time a controlled study and correlation analysis. Clinical characteristics and head CT / MRI findings in patients with acute exacerbation of COPD and CI. Results: Compared with patients with COPD alone, COPD had significantly lower AT-Ⅲ (234.39 ± 39.66 vs 278.90 ± 53.01, P <0.01) and increased DD and PASP (2.25 ± 2.07 vs 0.87 ± 0.61, P <0.01,42.50 ± 17.67 vs 32.48 ± 15.52, P <0.05), and in patients with COPD complicated by CI, the above 3 There is a correlation between the indicators. Fifteen of 37 COPD patients with acute exacerbation of CI had heart failure, and CT / MRI imaging showed mainly lacunar infarction (37 cases). Conclusions: AT-Ⅲ, D-D and PASP can be used as diagnosis and prophylactic treatment of COPD with CI. According to the above characteristics, COPD should be given anticoagulation therapy to control pulmonary artery pressure in order to reduce COPD complicated with CI.