脑梗死与高同型半胱氨酸血症的相关性研究

The relationship between cerebral infarction and hyperhomocysteinemia

目的探讨脑梗死与血浆同型半胱氨酸(HCY)水平的关系。方法120例脑梗死患者测定血浆HCY、叶酸、维生素B12、颈动脉内膜中层厚度、欧洲脑卒中量表评分等指标,并与60例健康对照者相比较。结果①脑梗死组的血浆HCY水平、颈动脉内膜中层厚度和甘油三酯明显高于对照组,而叶酸及维生素B12水平则低于对照组(P均<0.01)。②脑梗死与HCY水平之间存在危险性的水平梯度,当HCY>15μmol/L时,患者发生脑梗死的危险为正常人的5.909倍,而HCY≥20μmol/L时,患者发生脑梗死的危险为正常人的10.545倍。③从各项监测指标的相对危险度来看,与脑梗死有关的因素分别为HCY、叶酸、维生素B12、甘油三酯、颈动脉内膜中层厚度和收缩压、舒张压。条件Logistic回归模型检验发现HCY、甘油三酯、高密度脂蛋白、颈动脉内膜中层厚度和收缩压为脑梗死的独立致病因素。④脑梗死组和对照组血浆HCY水平与血叶酸、维生素B12水平、欧洲脑卒中量表评分均呈显著负相关性;HCY水平与颈动脉内膜中层厚度呈显著正相关性。结论高同型半胱氨酸血症是脑梗死的独立致病因素,导致高同型半胱氨酸血症的原因可能是血浆内叶酸和维生素B12的降低。

Objective To investigate the relationship between cerebral infarction and the plasma homocysteine level. Methods Levels of plasma homocysteine and folate and VitB12 of 120 cerebral infarction patients and 60 healthy subjects were determined. Results （1）The mean plasma level of homocysteine and TG and IMT were higher in cerebral infarction patients than that in control, and the very reverse of the plasma level of folate and VitB12 （P 〈 0.01 ）. （2）The higher the HCY, the more risky that the patients may suffer cerebral infarction. （3）Conditional logistic procedure analysis showed that HCY , TG, HDL, IMT and SBP were independent risky factors in cerebral infarction. （4）HCY was negatively correlated with folate and VitB12 and ESS, and positively correlated with IMT. Conclusion Hyperhomocysteinemia is independent risky factors in cerebral infarction. The cause of hyperhomocysteinemia may be the result from decrease of plasma folate and VitB12 levels.