颈动脉粥样硬化超声表现与血浆同型半胱氨酸浓度增高的关系研究

Study on the relation between the ultrasonographic features of carotid artery atherosclerosisand the high level of plasma homocysteine

目的:探讨颈动脉内膜-中层增厚及动脉粥样硬化(AS)斑块形成与血浆同型半胱氨酸(Hcy)浓度增高的关系。方法:选取87例首发急性脑血栓形成住院病人作为病例组,平均(66.13±12.54)岁;选取80例同期眼科和耳鼻喉科住院病人作为对照组,平均(64.94±11.26)岁。应用Sequia512彩超仪对病例组55例、对照组66例双侧颈总、颈内、颈外动脉进行扫查,测量颈动脉前后壁内膜-中层厚度(IMT),观察有无AS斑块形成及其位置,计算颈动脉狭窄程度。应用高效液相色谱-荧光法(HPLC-FD)测定两组所有病例的血浆Hcy浓度。并同时进行空腹血糖(FBS)、糖化血红蛋白(HbA1C)、肝肾生化、血脂、血压及体重指数(BMI)的测定。比较两组AS危险因素。结果:病例组和对照组平均空腹血浆Hcy浓度分别为(15.28±4.33)μmol?L和(11.32±3.86)μmol?L。病例组血浆Hcy浓度较对照组高且差异具统计学意义(P<0.001),病例组和对照组血浆Hcy升高者分别占31%和6.3%,差异具统计学意义(P<0.001)。病例组与对照组左、右颈动脉IMT及AS斑块发生率差异均有统计学意义(P<0.05)。比较两组AS危险因素,经Logistic回归分析,发现血浆Hcy浓度、收缩压、BMI是脑血栓形成的危险因素,在校正了高血压和肥胖后,血浆Hcy浓度升高是脑血栓形成的独立危险因素。结论:血浆Hcy浓度升高可?

Objective: To study the relation between carotid artery atherosclerosis(AS) and the high level of plasma homocysteine(Hcy). Materials and Methods: Eighty-seven subjects with first-ever acute cerebral thrombosis in our department of neurology were enrolled from July 2002 to July 2003 as the patient group, with an average of (66.13±12.54)years old. Eighty subjects in the department of ophthalmology and department of otorhinolaryngology were selected as control group, with an average of (64.94±11.26)years old. High frequency ultrasonography was used to detect carotid artery intimal-medial wall thickness(IMT), the existence of atherosclerotic plaques and the stenosis of carotid arteries. Fast blood was collected to determine total plasma Hcy level, FBS, HbA1C, hepatic and renal function, TC, TG, LDL and HDL. Blood pressure, body height and weight were taken. Results: Fast plasma Hcy level was higher in the patient group[(15.28±4.33)μmolL] compared with that in control group[(11.32±3.86)μmolL](t=6.28, P<0.001). In patient and control group, both differences in left and right carotid arteries IMT were statistically significant(t=3.647, P<0.001; t=4.118, P<0.001). The difference of incidence of carotid plaque was statistical significant(χ2=6.145, P=0.013). The risk factors were compared between the two groups. Logistic regression showed that plasma Hcy level, systolic pressure and BMI were the risk factors for cerebral thrombosis. There was no relationship between plasma Hcy level and either systolic pressure or BMI. Elevation in plasma Hcy level was an independent risk factor for acute cerebral thrombosis. Conclusion: Carotid artery AS correlate to high level of plasma Hcy.