Study On The Relationship Between Plasma Fibrin Level,SⅡ And Enlargement Of Perivascular Space In Patients With Acute Lacunar Infarction

Objective:To investigate the relationship between plasma fibrinogen level,systemic immune-inflammation index(SⅡ)and enlarged perivascular spaces(EPVS)in patients with acutelacunarcerebral infarction,and toanalyze theefficacy ofplasma fibrinogen leveland SⅡ in predictingtheseverityof EPVSinpatientswith acutelacunarcerebralinfarction.Methods:Acute lacunar infarction with perivascular space enlargement admitted to the Department of Neurology of Lianyungang Second People’s Hospital from January 2021 to June 2022 were retrospectively included.The number and severity of EPVS were evaluated by head MRI.They were divided into basal ganglia region(BG-EPVS),central semi-ovale region(CSO-EPVS)mild group(grade0-1:≤10)and moderateand severegroup(grade2-4:>10),The differences in general data between the BG-EPVS and CSO-EPVS groups were compared,and the independent riskfactors affecting the severity of EPVS in patients with acute lacunarcerebral infarction were determined by multifactorial binary logistic regression model analysis.The clinical value of plasma fibrinogen,SⅡ levels in predicting the severity of BG-EPVS in patients with acute lacunar cerebral infarction was assessed by plotting the area under the receiver operating characteristic(ROC)and the area under the curve(AUC).The correlation between plasma fibrinogen levels,SⅡ levels and moderate severity of BG-EPVS in patients with acute lacunarcerebral infarctionwas analyzed by Spearman correlation analysis andthedifference was consideredstatistically significantat P<0.05.Results:A total of 172 patients were included in this study,including 57 patients in the BG-EPVS mild group and 115 patients in the moderate-severe group,and 100 patients in the CSO-EPVS mild group and 72 patients in the moderate-severe group.Compared with the mild BG-EPVS group,the moderate-severe BG-EPVS group was significantly higher than the mild group in age,number of combined hypertension cases,neutrophil(NE)count,neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),SⅡ,total cholesterol(TC),high-density lipoprotein(HDL),and plasma fibrinogen.The differences were statistically significant(all P<0.05);the age was significantly higher in the mild CSO-EPVS group compared with the moderate-severe CSO-EPVS group,and the differences were statistically significant(P<0.05).Multifactorial logistic regression analysis showed that age[OR(95%CI)=1.048(1.010-1.088)],plasma fibrinogen[OR(95%CI)=2.001(1.087-3.686)],and SⅡ level[OR(95%CI)=1.004(1.001-1.008)]were the most important factors in acute independent risk factors for the severity of BG-EPVS in patients with lacunar cerebral infarction(P<0.05).ROC curve analysis showed that plasma fibrinogen level had a predictive value for moderate to severe BG-EPVS in patients with acute lacunar cerebral infarction[AUC(95%CI)=0.693(0.611-0.775),P<0.001],with an optimal cut-off value was 4.00 g/L,which corresponded to a sensitivity of 61.7%and a specificity of 80.7%;meanwhile,SⅡ levels had some value in predicting moderately severe BG-EPVS in patients with acute lacunar cerebral infarction[AUC(95%CI)=0.717(0.638-0.796),P<0.001],with a best cut-off value of 686.35×10~9/L,which corresponded to a sensitivity of 47.8%and specificity of 91.2%;when plasma fibrinogen combined with SⅡ could further improve the predictive value of moderate to severe BG-EPVS in patients with acute lacunar cerebral infarction[AUC(95%CI)=0.772(0.699-0.845),P<0.001],with a sensitivity of 66.1%and specificity of 82.5%.Spearman correlation analysis showed a positive correlation between plasma fibrinogen(r_s=0.315,P<0.001)and SⅡ(r_s=0.354,P<0.001)andtheseverityof BG-EPVSinpatientswithacutelacunarcerebralinfarction.Conclusions:1.Plasma fibrinogen and SⅡ levels are independent risk factors for the severity of BG-EPVS in patients with acute lacunar cerebral infarction,and also age is a risk factor for the severity of BG-EPVSand CSO-EPVSinpatientswith acutelacunarcerebralinfarction.2.Plasma fibrinogen and SⅡ levels have some predictive value in assessing the severity of BG-EPVS in patients with acute lacunar cerebral infarction,and the combination of both can furtherimprovetheirpredictivevalue.3.Plasma fibrinogen and SⅡ levels were positively correlated with BG-EPVS in patients with acute lacunar cerebral infarction,and the higher the plasma fibrinogen and SⅡ levels,the more severethe BG-EPVSlesion.