脑梗死与血浆同型半胱氨酸水平及颈动脉粥样硬化的相关性研究

Study on the relationship among cerebral infarction and plasma homocysteine and carotid atherosclerosis

目的探讨脑梗死与血浆同型半胱氨酸水平及颈动脉粥样硬化之间的相关性。方法选择脑梗死患者120例为脑梗死组,同期选择年龄及性别相匹配的健康体检者70例为对照组,然后根据颈动脉多普勒彩色超声检查结果将脑梗死组分为脑梗死A组(有斑块)及脑梗死B组(无斑块),将对照组分为对照A组(有斑块)及对照B组(无斑块)。脑梗死A组及对照A组为斑块组,脑梗死B组及对照B组为无斑块组。所有研究对象均记录年龄、性别、吸烟、饮酒、高血压、糖尿病等既往史,测定血浆同型半胱氨酸水平(Hcy),应用颈动脉多普勒彩色超声检查患者颈动脉内膜中层厚度(IMT)。结果脑梗死患者的血浆Hcy水平、IMT及颈动脉斑块数均较对照组明显增高,斑块组血浆Hcy水平及IMT均高于无斑块组,脑梗死A组血浆Hcy水平IMT均较脑梗死B组高,对照A组血浆Hcy水平及IMT均较对照B组高,差异均有统计学意义(P<0.05)。直线相关分析显示血浆Hcy水平及IMT呈正相关(r=0.86,P<0.05)。结论血浆Hcy水平及颈动脉粥样硬化与脑梗死存在密切关系,高Hcy血症为脑梗死的独立危险因素,高血浆Hcy水平可加快、加重颈动脉粥样硬化而引发脑梗死。

Objective To investigate the relationship among cerebral infarction,plasma homocysteine,and carotid atherosclerosis.Methods Totally 120 patients were chosen as the cerebral infarction group and other 70 healthy people as control group.According to the results of carotid Doppler ultrasonography,the cerebral infarction group was divided into two subgroups,cerebral infarction with carotid atherosclerotic plaque and cerebral infarction without plaque.And the controls were also divided into two subgroups,control with carotid atherosclerotic plaque and control without plaque.The levels of plasma homocysteine were measured.The changes of carotid intimal-medial thickness（IMT）were examined by carotid duplex ultrasonography scanning.Results The plasma level of Hcy and IMT and the number of carotid atherosclerotic plaque were significantly higher in the cerebral infarction group than those in control group（P0.05）.The plasma level of homocysteine was significantly higher in plaque group than that in non-plaque group（P0.05）.The plasma level of homocysteine was higher in the CI with carotid atherosclerotic plaque group than that in the control with plaque group（P0.05）.The plasma level of homocysteine was higher in the CI without carotid at herosclerotic plaque group than that in the control without plaque group（P0.05）.The level of Hcy was related to IMT（P0.05）.Conclusion Plasma homocysteine is closely related to atherosclerosis and cerebral infarction,and it is one of the most important risk factors of carotid atherosclerosis.High plasma homocysteine can quicken and aggravate carotid atherosclerotic,and initiate cerebral infarction.