胱抑素C、同型半胱氨酸与颈动脉斑块稳定性的相关性

Association between cystatin C and homocysteine level with carotid artery plaque stability

目的 探讨胱抑素C、同型半胱氨酸与急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系.方法 回顾性分析马鞍山中心医院治疗的108例存在颈动脉斑块的脑梗死患者,根据颈动脉彩色多普勒超声的监测结果将患者分为不稳定斑块（62例）组和稳定性斑块（46例）组,比较两组患者同型半胱氨酸、胱抑素C、C反应蛋白、低密度脂蛋白等危险因素,并分析上述因素对斑块稳定性的影响.结果 （1）不稳定斑块组和稳定斑块组间同型半胱氨酸[（13.60±2.20） μmol/L比（6.29±1.42） μmol/L]、血清胱抑素C[（1.24±0.22）mg/L比（0.87±0.22）mg/L]、C反应蛋白[（12.6±2.29）mg/L比（6.18±2.31）mg/L]、低密度脂蛋白水平[（2.8±1.10） mmol/L比（1.94±0.58） mmol/L]比较差异有统计学意义（t分别为24.49、51.98、32.73、13.19,均P＜0.01）;（2）不稳定斑块组患者血清胱抑素C与血浆同型半氨酸之间存在弱相关性（r=0.26,P=0.002）;（3）多因素Logistic回归分析显示C反应蛋白、低密度脂蛋白胆固醇、胱抑素C与同型半氨酸为颈动脉粥样硬化斑块不稳定的独立危险因素（OR=2.56,95％CI：1.01～6.55,P=0.05;OR=1.43,95％CI：1.07～1.92,P=0.017;OR=3.89,95％CI：1.27～11.9,P=0.016;OR =2.18,95％CI：1.63～2.93,P=0.000）.结论 除C反应蛋白、低密度脂蛋白外,胱抑素C、同型半胱氨酸也是颈动脉斑块不稳定的重要因素.

Objective To investigate the relationship between serm cystatin C （Cyst-C） and homocysteine （Hcy） with carotid artery plaque stability in patients with cerebral infarction.Methods A total of 108 cerebral infarction patients with carotid artery plaque treated in Maanshan Central Hospital were enrolled retrospectively in the study.According to color Dopper findings,the patients were divided into the unstable plaque group （62） and the stable plaque group （46）.The related risk factors,the serm levels of Hey,Cyst-C,CRP,and LDL-C were detected and compared between the two groups.Results There were significant differences of the Hcy [（13.60± 2.20） μmol/L vs.（6.29 ± 1.42） μmol/L,t =24.49,P＜0.01],Cyst-C[（1.24±0.22） mg/L vs.（0.87±0.22） mg/L,t=51.98,P＜0.01],CRP [（12.60±2.29） mg/L vs.（6.18±2.31） mg/L,t=32.73,P＜0.01],LDL-C [（2.80±1.10） mmol/Lvs.（1.94±0.58） mmol/L,t =13.19,P＜0.01] between the observation group and the control group.The level of Cyst-C concentration was weak positive correlated with Hcy （r=0.26,P＜0.05）.Multivariate logistic regression analysis showed CRP,LDL-C,Cyst-C and Hcy were independent risk factors for carotid artery plaque instability in patients with cerebral infarction（OR=2.56,95％CI1.01 to 6.55,P=0.05; OR=1.43,95％CI1.07to1.92,P=0.017;OR =3.89,95％ CI 1.27 to 11.9,P=0.016; OR=2.18,95％CI 1.63 to 2.93,P=0.000,respectively）.Conclusions Apart from CRP and LDL-C,Cyst-C and Hcy were also important risk factors for carotid plaque instability.