肱动脉内皮功能及血清同型半胱氨酸水平与颅内动脉狭窄的关系

Correlation between brachial artery endothelial function,serum homocysteine level and intracerebral artery stenosis

目的探讨缺血性脑血管病(ICVD)患者肱动脉血流介导的血管扩张(FMD)、非内皮依赖性舒张(NMD)及血清同型半胱氨酸(Hcy)水平与颅内动脉狭窄程度的相关性。方法对100例ICVD患者行数字减影全脑血管造影(DSA),根据DSA结果将患者分为颅内动脉正常组(21例)、轻度狭窄组(25例)、中度狭窄组(21例)和重度狭窄组(33例),检测各组FMD、NMD、血清Hcy水平。结果颅内动脉正常组及轻、中、重度狭窄组FMD分别为(7.79±2.51)%、(4.96±1.43)%、(5.00±1.56)%、(5.02±2.15)%;NMD分别为(14.31±6.76)%、(12.54±5.40)%、(16.52±4.79)%、(13.27±9.22)%;血清Hcy分别为(10.07±3.18)μmol/L、(13.84±7.63)μmol/L、(14.91±6.70)μmol/L、(14.88±6.14)μmol/L;与颅内动脉正常组比较,颅内动脉轻、中、重度狭窄组FMD显著降低、血清Hcy水平显著增高(P<0.05～0.01),轻、中、重度狭窄组间差异无统计学意义;4组间NMD差异无统计学意义。FMD与颅内动脉狭窄程度及血清Hcy水平负相关(r=-0.338,r=-0.203;P<0.05～0.01);血清Hcy水平与颅内血管狭窄程度正相关(r=0.309,P<0.01)。Logistic回归分析显示FMD降低及血清Hcy水平增高预测颅内动脉狭窄的比值比(OR)为0.580和1.183。结论高Hcy血症(HHcy)与内皮功能失调有关,FMD降低、HHcy是颅内动脉狭窄的预测因子。

Objective To explor the correlation between flow-mediated dilatation（FMD）,nitroglycerin-mediated dilation（NMD）in the brachial artery,the serum homocysteic acid（Hcy） level and the extent of intracerebral artery stenosis.Methods By the digital subtraction angiography（DSA）,the 100 patients with ischemic cerebrovascular disease（ICVD）were divided into the intracerebral artery normal group （21 cases）,and slight,midrange and severe stenosis groups （25 cases,21 cases and 33 cases,respectively）. The FMD and NMD in the brachial artery and the level of serum Hcy were detected in each group.Results The FMD in the intracerebral artery normal group,slight,midrange and severe stenosis groups were （7.79±2.51）%,（4.96±1.43）%,（5.00±1.56）% and （5.02±2.15）%; the NMD were（14.31±6.76）%,（12.54±5.40）%,（16.52±4.79）% and （13.27±9.22）%; the level of serum Hcy were （10.07±3.18）μmol/L,（13.84±7.63）μmol/L,（14.91±6.70）μmol/L and（14.88±6.14）μmol/L,respectively. Compared with normal group,the FMD were significantly lower,the levels of serum Hcy were significantly increased in the slight,midrange and severe intracerebral artery stenosis groups （P0.05-0.01）. There was no significantly difference of FMD and the level of serum Hcy among the groups of slight,midrange and severe intracerebral artery stenosis; and no significantly difference of NMD among the 4 groups. The FMD were negative correlated with intracerebral artery stenosis and level of serum Hcy （r=-0.338,r=-0.203; all P0.01）; and Hcy was positive correlated with intracerebral artery stenosis （r=0.309,P0.01）. Logistic regression analysis showed that the odds ratio（OR） of lower FMD and hyper homocystinemia（HHcy） for intracerebral artery stenosis were 0.580 and 1.183,respectively.Conclusions HHcy is related to endothelial dysfunction. Lower FMD and HHcy are predicting factors for intracerebral artery stenosis.