Analysis Of Risk Factors For Cerebral Small Vessel Disease And The Diagnostic Value Of Serum FIB,D-dimer,CysC,Hcy And ?-GGT

Objective: By detecting the levels of fibrinogen(FIB),D-dimer,cystatinC(CysC),ho-mocysteine(Hcy)and gamma-glutamyl transferase(?-GGT)in serum of patients with cerebral small vessel disease(CSVD)and control group,the diagnostic value of these serum indic-ators was analyzed,and the possible risk factors of CSVD were discussed,which could pr-ovide basis for the prevention and treatment of CSVD.Methods:449 patients with CSVD admitted to the department of neurology of Lanzhou University Second Hospital from October 2016 to January 2019 were collected as the CSVD group.According to inclusion and exclusion criteria,CSVD patients were further divided into white matter hyperintensity group(WMH group)(113 cases),1acunar infarction group(LI group)(101 cases),cerebral microbleeds group(CMB group)(102 cases)and Mixed group(133 cases).102 hospitalized patients with no significant difference in age and gender,no abnormal changes in cranial MRI and no positive signs of nervous system were selected as control group.Clinical data including age,sex,hypertension,diabetes mellitus,FIB,D-dimer and biochemical indicators(fasting blood glucose(GLU),CysC,Hcy,?-GGT,Uric Acid(UA),Total cholesterol(TC),Triglyceride(TG),Low density lipoprotein(LDL),High density Lipoprotein(HDL),Lipoprotein(a)(LPa))were recorded.The risk factors of CSVD and the diagnostic value of serum FIB,D-dimer,CysC,Hcy and ?-GGT were analyzed.Results: 1.The differences between CSVD group,WMH group,LI group,CMB group,mixed group and control group were compared:(1)The levels of hypertension,FIB,D-dimer,CysC,Hcy,LPa and UA in CSVD group were significantly higher than those in control group(all P<0.05).However,there was no significant difference in age,?-GGT,GLU,TC,TG,LDL and HDL between the two groups;(2)The levels of hypertension,FIB,D-dimer,CysC,Hcy,UA and TC in WMH group were higher than those in control group(all P<0.05),while the levels of TG and ?-GGT in WMH group were lower than control group(all P<0.05).There was no significant difference in age,GLU,LDL,HDL and LPa between the two groups(P>0.05);(3)Hypertension,FIB,D-dimer,CysC,Hcy,UA,TC,LPa and ?-GGT in LI group were significantly higher than those in control group(all P<0.05),but there was no significant difference in age,GLU,TG,LDL and HDL between the two groups(P>0.05);(4)The levels of CysC,Hcy,UA and TG in CMB group were higher than those in control group(P<0.05),while TC in CMB group was lower than that in control group(P<0.05).There was no significant difference in age,FIB,D-dimer,?-GGT,GLU,LDL,HDL and LPa between the two groups(P > 0.05);(5)The levels of hypertension,FIB,D-dimer,CysC,Hcy,UA,TC and LPa in Mixed group were significantly higher than those in control group(all P<0.05);However,there was no significant difference in age,?-GGT,GLU,TG,LDL and HDL between the two groups(P > 0.05).2.Logistic regression analysis of five groups:(1)After controlling the confounding factors,FIB,D-dimer,CysC,Hcy,LPa and UA were correlated with cerebrovascular disease(P<0.05),which was an independent risk factor for CSVD;(2)FIB,D-dimer,CysC,Hcy,UA,TC were positively correlated with WMH(P<0.05),and the above factors were independent risk factors for WMH;while TG was negatively correlated with WMH(P<0.05),which was a protective factor for WMH;(3)FIB,D-dimer,CysC,UA,TC,LPa and ?-GGT were positively correlated with LI(P<0.05),and the above factors were independent risk factors for LI,while Hcy was not correlated with LI(P> 0.05);(4)CysC,Hcy,UA,TG were positively correlated with CMB(P<0.05),The above factors were independent risk factors for CMB,while TC was protective factor for CMB;(5)FIB,D-dimer,CysC,Hcy,LPa,TC and UA were correlated with Mixed group(P<0.05).3.ROC curve analysis:(1)Serum FIB,D-dimer,CysC and Hcy had diagnostic value for CSVD(AUC>0.5,P<0.05);The diagnostic threshold of serum FIB was 3.14,sensitivity was 34%,specificity was 88%;The diagnostic threshold of serum D-dimer was 0.28,sensitivity was 68%,specificity was 59%;The diagnostic threshold of serum CysC was 0.79,sensitivity was 85%,specificity was 47%;The diagnostic threshold of serum Hcy was 22.50,sensitivity was 46%,specificity was 78%;While,serum ?-GGT had no diagnostic value for CSVD(AUC<0.5,P>0.05);(2)Serum FIB,D-dimer,CysC and Hcy had diagnostic value for WMH(AUC>0.5,P<0.05);The diagnostic threshold of serum FIB was 2.88,sensitivity was 55%,specificity was 72%;The diagnostic threshold of serum D-dimer was 0.24,the sensitivity was 83%,and the specificity was 51%;The diagnostic threshold of serum CysC was 0.79,the sensitivity was 89%,and the specificity was 47%;The diagnostic threshold of serum Hcy was 22.50,the sensitivity was 57%,and the specificity was 76%;While,serum ?-GGT had no diagnostic value for WMH(AUC<0.5,P>0.05);(3)Serum FIB,D-dimer,CysC and ?-GGT had diagnostic value for LI(AUC>0.5,P<0.05);The diagnostic threshold of serum FIB was 2.93,sensitivity was 60%,specificity was 79%;The diagnostic threshold of serum D-dimer was 0.28,sensitivity was 83%,specificity was 59%;The diagnostic threshold of serum CysC was 0.79,sensitivity was 81%,specificity was 47%;The diagnostic threshold of serum ?-GGT was 32.50,the sensitivity was 52%,and the specificity was 74%;While,serum Hcy had only a low diagnostic value for LI(AUC=0.58,P<0.05);(4)Serum CysC and Hcy had diagnostic value for CMB(AUC>0.5,P<0.05);The diagnostic threshold of serum CysC was 0.83,sensitivity was 79%,specificity was 55%;The diagnostic threshold of serum Hcy was 26.50,the sensitivity was 37%,and the specificity was 91%;While,serum FIB,D-dimer and ?-GGT had no diagnostic value for CMB(AUC<0.5,P>0.05).Conclusion: 1.Serum FIB,D-dimer,CysC,Hcy,?-GGT and LPa may be independent risk factors and may have diagnostic value for CSVD,but there are differences in risk factors and diagnostic value for WMH,LI and CMB.2.Serum TC may be a protective factor for CMB and serum TG may be a protective factor for WMH.