CHANGES AND RELATIONSHIP OF PLASMA HCY LEVELS AND COAGULATION AND FIBRINOLYSIS INDEXES IN PATIENTS WITH ACUTE CEREBRAL INFARCTION OF DIFFERENT SEVERITY AND ETIOLOGY

Zhihua Cheng, Cong Luo, Zhilin Guo^*

Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, PR China

Objective: To explore the changes of plasma homocysteine (HCY) level and coagulation and fibrinolysis indexes in patients with acute cerebral infarction of different severity and etiology. 

Methods: Ninety-four patients with acute cerebral infarction (ACI) hospitalized in the neurology department of our hospital from May 2016 to January 2018 were randomly selected as the experimental group. The patients were divided into mild ACI group, moderate ACI group and severe ACI group according to the severity of the disease. They were further divided into large artery atherosclerosis (LAA) group, cardiogenic embolism (CE) group, small artery occlusion (SAO) group, and SOE + SUE group with unknown etiology. Fifty healthy adults who underwent physical examination in our hospital during the same period were selected as the control group. The levels of HCY, activated partial thromboplastin time (APTT), plasma thrombin time (TT), plasma prothrombin time (PT), plasma fibrinogen degradation products (FDP), plasma fibrinogen (Fg) and plasma D-dimer (DD) were compared between the experimental and control groups, and the relationship between plasma HCY levels and coagulation and fibrinolysis indexes was further analyzed. 

Results: The levels of HCY and Fg in the experimental group were significantly higher than those in the control group (P<0.05), while levels of APTT and DD were significantly lower than those in the control group (P<0.05). There was no significant difference in the levels of PT, TT and FDP between the two groups (P>0.05). HCY levels in mild ACI group, moderate ACI group and severe ACI group were significantly higher than those in the control group (P<0.05), and HCY levels in severe ACI group and moderate ACI group were significantly higher than those in mild ACI group (P<0.05). APTT levels in mild ACI group, moderate ACI group and severe ACI group were significantly lower than those in the control group (P<0.05), and APTT levels in moderate ACI group and severe ACI group were significantly lower than those in mild ACI group (P<0.05). Fg levels in moderate ACI group and severe ACI group were significantly higher than those in mild ACI group (P<0.05). There was no significant difference in TT and FDP levels among groups (P>0.05). DD levels in moderate ACI group and severe ACI group were significantly higher than those in mild ACI group and the control group (P<0.05). HCY levels in CE group, SAO group and other groups were significantly lower than those in LAA group (P<0.05). APTT levels in CE group, SAO group and other groups were significantly higher than those in LAA group (P<0.05). There was no significant difference between the other two groups (P>0.05). HCY was negatively correlated with APTT and positively correlated with Fg and DD. There was no significant correlation with PT, TT and FDP. 

Conclusion: There is a significant correlation between plasma HCY and APTT, Fg and DD in patients with acute cerebral infarction, and the more severe the disease, the higher the level of HCY, and the worse the stability of coagulation and fibrinolysis system. Meanwhile, plasma HCY may be more correlated with LAA-ACI.