脑梗死患者血清同型半胱氨酸与颅内外血管狭窄的相关性

The relationship between the plasma homocysteine level and cerebral vascular stenosis in patients with cerebral infarction

目的探讨脑梗死患者血清同型半胱氨酸(Hcy)与颅内外血管狭窄的相关性。方法对行DSA检查的116例脑梗死患者进行分组,根据DSA所提示的颅内外血管狭窄的检查结果分为颅内外血管狭窄组(91例)、颅内外血管无狭窄组(25例);按狭窄部位又将狭窄组分为单纯颅内血管狭窄组(28例)、单纯颅外血管狭窄组(34例)及颅内外血管均有狭窄组(29例)。记录所有患者的常规危险因素,如年龄、性别、高血压、糖尿病、吸烟、饮酒及血生化指标如血清同型半胱氨酸(Hcy)、甘油三脂(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)等。结果(1)颅内外血管狭窄组血清Hcy升高的水平及比例明显大于对照组,分别为(17.6±10.1)mmol/L和(12.6±2.6)mmol/L,P=0.002;39.6%和16.0%,P=0.002。多元逐步Logistic回归分析发现,血清Hcy水平升高(OR=1.243,95%CI:1.047～1.476,P=0.013)、HDL降低(OR=0.089,95%CI:0.014～0.551,P=0.009)是颅内外血管狭窄的危险因素。(2)对于不同的狭窄亚组,血清Hcy升高的水平及比例在各组间无差异,分别为(18.1±10.9)mmol/L、(17.0±8.9)mmol/L、(17.7±10.7)mmol/L;比例分别为42.9%、38.2%、37.9%,P=0.11;多元逐步Logistic回归分析发现,血清Hcy升高是所有狭窄亚组的重要的危险因素(OR分别为1.367、1.232、3.846)。结论血清同型半胱氨酸水平升高是颅内外血管狭窄的危险因素。

Objective To investigate the relationship between the plasma homocysteine level and cerebral vascular stenosis in patients with cerebral infarction. Methods 116 adult patients with cerebral infarction experienced cerebral digital substraction angiography （DSA）were selected. Among them, 91 patients with cerebrovascular stenosis and 25 patients without stenosis were included. Three groups were categorized by distribution of artery lesion sites： isolated intracranial artery stenosis （n = 28）, isolated extracranial artery stenosis（n= 34）, co-existing of intracranial and extracranial artery stenosis （n= 29）. Conventional risk factors of cerebral infarction such as sex, age, hypertension, diabetes, smoking, alcohol, plasma homocysteine（Hcy）, triglyceride（TG）, high-density liprotein（HDL）, low-density liprotein（LDL）were evaluated in 116 subjects. Results （1） The proportion of subjects with high level of plasma homocysteine was significantly higher in patients with cerebrovascular stenosis than those without [（17.6± 10. 1） mmol/L versus （12.6±2.6） mmol/L, P=0. 002;39.6 % versus 16.0 %, P=0. 002]. Based on multivariable stepwise Logistic regression model, the odds ratio of homocysteine levels was 1. 243 （95 % CI： 1. 047 - 1. 476, P = 0. 013） with additional adjustment for convention risk factors. Plasma homocysteine was an independent risk factor for cerebral vascular stenosis. （2）For the different groups of artery lesion sites, the proportion of subjects with high level of plasma homocysteine was not significantly different [（18. 1 ±10. 9）mmol/L, （17.0±8.9）mmol/L, （17.7±10. 7） mmol/L;42.9% ,38. 2%,37.9%, P=0.11], but high level of plasma homocysteine was an important risk factor by additional adjustment for conventional risk factors. Conclusion It is suggested that high level of plasma homocysteine is an independent risk factor for cerebral vascular stenosis.