脑卒中与血浆同型半胱氨酸水平的关系(英文)

Relationship between plasma homocysteine level and stroke

背景:很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素。目的:探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系,并分析可能影响同型半胱氨酸水平的相关因素。设计:病例-对照实验。单位:浙江大学医学院附属第二医院神经内科。对象:选择2003-01/11在浙江大学医学院附属第二医院的住院患者57例,其中脑卒中57例(脑出血组21例,脑梗死组36例),并以同期到本院作体检的健康人28例作为对照组。方法:所有被试者均晨起空腹抽取静脉血2mL,测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量,并对所有患者进行临床神经功能缺损程度评分,脑出血组患者根据CT摄片计算出每例患者的血肿体积。主要观察指标:①各组被试者血浆同型半胱氨酸水平。②血浆同型半胱氨酸水平与叶酸,维生素B12,临床神经功能缺损程度评分及血肿体积的相关性。结果:57例脑卒中患者和28例健康者全部进入结果分析。①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组([25.2±21.4),(18.3±10.9),(11.5±2.9)μmol/L;(22.8±18.9),(14.7±7.4),(10.8±2.6)μmol/L,P<0.05～0.01]。脑梗死组和脑出血组基本接近(P>0.05)。②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关(r=-0.442,-0.531,P<0.05),与维生素B12水平无显著相关性(r=-0.086,-0.111,P>0.05)。脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性(r=-0.139,P>0.05),脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性(r=0.225,0.425,P>0.05)。结论:高同型半胱氨酸血症是脑梗死和脑出血的危险因素。血浆同型半胱氨酸水平与叶酸水平呈负相关,与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关。

BACKGROUND： Hyperhomocysteinemia has been suggested to be a possible independent risk factor： for stroke. OBJECTIVE： To explore the relationship between hypcrhomocysteinemia and cerebral infarction and hemorrhage, and analyze the factors that affect plasma homocysteine level. DESIGN： Case-controlled clinical trial. SETTING： Department of Neurology, Second Hospital Affiliated to Medi- cal College of Zhejiang University. PARTICIPANTS： Totally 57 patients including 21 with cerebral hemorrhage and 36 with brain infarction were treated in the Department of Neurology, Second Hospital Affiliated to Medical College of Zhejiang University Between January and November 2003. Twenty-eight healthy volunteers were also recruited from the subjects coming for routine physical examination. METHODS： Two milliliters of fasting venous blood was collected from all subjects in the morning for detecting the contents of plasma homocysteinc, vitamin B12, folic acid, creatinine and so on. All patients were scored for clinical neurological impairment, with the hematoma volume calculated in patients with brain hemorrhage determincd on the basis of CT scanning. MAIN OUTCOME MEASURES： ① Plasma homocysteine level in each group. ② Relationship between plasma homocysteic acid level and folic acid, vitamin B12, clinical neurological impairment score and hematoma volunle. RESULTS： Valid results were obtained from all the 57 stroke patients and 28 healthy cnntrols for analysis. ① Plasma homocvstcine level was higher in male and female patients of both cerebral infarction group and cerebral hemorrhage group than that of the subjects of the same gender in the control group [（25.2±21.4）, （18.3±10.9）, （11.5±2.9） μmol/L for male subjects; （22.8±18.9）, （14.7±7.4）, （10.8±2.6） μmol/L for female subjects, P〈 0.05-0.01]. The level of homocysteine was similar between cerebral infarction group and cerebral hemorrhage group （P 〉 0.05）; ② In cerebral infarction group and cerebral hemorrhage group, homocysteic acid level showed obvious inverse correlation with folic acid level （r=-0.442, -0.531, P 〈 0.05）, but without relation to vitamin B,2 level （r=-0.086. -0.111, P 〉 0.05）. Homocysteine level was not obviously correlated to the neurological impairment scores in cerebral infarction group （r=-0.139, P 〉 0.05）, nor was it related to the scores or hematoma volume in cerebral hemorrhage group （r=0.225, 0.425, P 〉 0.05）. CONCLUSION： Hyperhomocysteinemia is risk factor for cerebral infarc- tion and hemorrhage. Plasma homocysteine level is inversely correlated with folie acid level, but not ohviously related to vitamin B12, clinical neurologicla impairment score or hcmatoma volume.