血浆同型半胱氨酸水平与动脉粥样硬化和脑梗死的关系

Homocysteine,atherosclerosis and cerebral infartion

目的探讨血浆同型半胱氨酸(Hcy)水平与颈动脉粥样硬化和脑梗死关系。方法2005-05～2006-02收治的91例脑梗死住院患者被列入研究对象。根据病灶大小分3组:大片梗死21例,小片梗死44例,腔隙性梗死26例。根据颈动脉彩超检测结果将研究对象分为颈动脉斑块组34例,无颈动脉斑块组57例。全部患者测定血浆Hcy、血清叶酸、VitB12水平。分析血浆Hcy水平与脑梗死的危险因素、病灶大小、颈动脉粥样硬化斑块及血清叶酸、VitB12的关系。结果血浆Hcy水平:(1)与高血压、糖尿病、血脂、性别、年龄各指标无明显相关关系。(2)与脑梗死病灶大小无关。(3)与颈动脉粥样硬化斑块有关,有斑块34例,血浆Hcy(20.73±9.31)μmol/L,无斑块57例,血浆Hcy(15.46±11.4)μmol/L,前者高于后者(P<0.05)。(4)与血清叶酸、VitB12水平呈负相关(r1s=-0.264,r2s=-0.16,P<0.05)。结论血浆Hcy水平与脑梗死病灶大小无关;Hcy水平升高与颈动脉粥样硬化斑块密切相关;与血清叶酸、VitB12水平呈负相关。高血浆Hcy血症可能是颈动脉粥样硬化的危险因素,但与脑梗死关系不明确。

Objective To study the relations among plasma homocysteine （Hey） and atherosclerosis, cerebral infarction. Methods 91 cerebral infarction patients were included in this study. By the size of cerebral infarction（C1） ,patients were divided into three groups： large infarction（21）, small infarction（44） and lacunar infarction（26）. According to the results of carotid Doppler ultrasongraphy, patients were re--divide into two subgroups; CI with carotid atherosclerotic plaque（34） and CI without plaque（57） . The relations among Hey and hypertension, diabetes, blood lipid, sex, age, the size of cerebra infarction, carotid atherosclerotic plaque, vitamin B12, serumfolic acid were analyzed. Results （1） Relations among Hey and hypertension, diabetes, blood lipid, sex, age were not significant. （2） There were no correlations between Hey and the size of cerebral infarction. （3）Hey level in CI with carotid atherosclerotic plaque was higher than that in CI without plaque（P〈0.05）. （4）Negative correlation was found between Hey and the level of vitamin B12 and serum folic acid （r1s=-0. 264,r2s=-0.16,P〈0. 05））. Conclusion Plasma Hey level had a close corespondence with carotid atherosclerotic plaque, while no correlation with the size of cerebral infarction. It suggested that high level of Hcy may be the dangerous factor of carotid atherosclerotic, but the relation with cerebral infarction was still not clear.