急性脑梗死患者血浆Hcy水平及相关因素分析

Analysis of plasma homocysteine levels and the related factors in patients with acute cerebral infarction

目的探讨血浆同型半胱氨酸(Hcy)在急性脑梗死发生发展中的作用,并分析其相关因素。方法取30例急性脑梗死患者为观察组,同期30例健康体检者为对照组。采用化学发光法检测两组血浆Hcy、维生素B12及叶酸水平。两组均行颈动脉彩超检查,测定颈动脉内膜中层厚度(IMT),观察有无动脉粥样硬化。结果观察组血浆Hcy水平明显高于对照组(P<0.05);高Hcy血症(Hcy>15μmol/l)发生率明显高于对照组P<0.05;血浆维生素B12及叶酸水平均明显低于对照组、P均<0.05。观察组23例高Hcy血症患者中,血浆维生素B12下降15例,叶酸下降12例,两者同时下降7例。血浆Hcy水平与维生素B12及叶酸水平呈显著负相关(r分别为-0.624、-0.719,P均<0.01)。观察组IMT明显高于对照组,颈动脉粥样硬化发生率明显高于对照组,P均<0.05。直线相关分析表明,血浆Hcy水平与颈动脉IMT呈正相关(r=0.489,P<0.001)。结论急性脑梗死患者血浆Hcy水平升高,其与维生素B12及叶酸水平呈负相关,与颈动脉粥样硬化程度呈正相关。

Objective To analyze the effects of homocysteine （Hcy） on the occurrence and development of acute cerebral infarction and its related factors. Methods In this study, 30 cases of patients with acute cerebral infarction （observation group） and 30 patients with the same period in healthy subjects （ control group）. The levels of plasma Hey, vitaminB12 and folic acid were detected by chemiluminescence method. Both the two groups underwent color doppler ultrasound examination of carotid artery, and carotid artery intima-media thickness （IMT） was measured, meanwhile, to observe whether there was atherosclerosis. Results Both the plasma Hcy levels and the proportion of Hhcy（ hyperhomocysteine- mia） in observation group were significantly higher than those in control group （all P 〈0.05 ） ; whereas the levels of vitaminB12 and folic acid were significantly lower than those in control group（ all P 〈 0.05）. In observation group, there were 23 cases of patients with HHey; during whom, 15 cases with decreasing plasma vitaminB12, 12 cases with decreasing folic acid, and 7 cases with both decreasing plasma vitaminBn and folic acid. The plasma Hey level was negatively correlated with vitaminB12 and fotic acid levels （r = -0.624, -0.719, all P 〈0.01 ）. Both IMT and the occurrence rate of carotid atherosclerosis in observation group were significantly higher than those in control group （ all P 〈 0.05）. Linear correlation analysis showed that the plasma Hey level was positively correlated with carotid artery IMT （r = 0.489, P 〈 0. 001 ）. Conclusion Elevated levels of plasma Hey in patients with acute cerebral infarction are negatively correlated with vitaminBn and folic acid levels, and positively correlated with the degrees of carotid atherosclerosis.