急性脑梗死患者血浆同型半脘氨酸水平及其与改良急性卒中治疗低分子肝素试验病因分型的关系

The Concentration of Plasma Homocysteine in Patients with Acute Cerebral Infarction and its Relationship with TOAST Subtypes

目的探讨急性脑梗死患者血浆中同型半胱氨酸(Hcy)的水平变化及其与改良急性卒中治疗低分子肝素试验(TOAST)病因分型间的关系,为脑梗死的防治提供依据。方法采用回顾性分析,选择2012年4月-2013年4月收治的急性脑梗死患者120例为脑梗死组;按照2007年韩国改良TOAST病因分型分为5种不同的亚型,即动脉粥样硬化血栓形成型(AT)48例(40.0%)、小动脉疾病型(SAD)36例(30.0%)、心源性栓塞型(CE)14例(11.7%)、其他原因卒中型(SOD)2例(1.6%)、不明原因卒中型(SUD)20例(16.7%)。同时选择同期健康体检者60例为对照组,检测各组的血浆Hcy水平,分析改良TOAST各亚型与Hcy水平的关系。结果脑梗死组患者血浆Hcy水平高于对照组(P<0.01);脑梗死改良TOAST各亚型中SOD因例数少未作分析,其他各型中AT、SAD、CE、SUD组血浆Hcy水平均高于对照组(P<0.05),AT组Hcy水平与SAD组相比差异无统计学意义(P>0.05);AT组高于SUD组与CE组,差异有统计学意义(P<0.05)。结论脑梗死与高Hcy血症有关,各亚型的血浆Hcy水平均增高并随TOAST亚型的不同而变化,AT、SAD亚型水平最高,提示高Hcy血症可能通过致动脉粥样硬化和对血管内皮细胞损伤引起脑梗死。

Objective To explore the concentration of the plasma homocysteine （Hcy） and the relationship with TOAST subtypes in patients with acute cerebral infarction. Methods A total of 120 patients with acute cerebral infarction （ACI） treated from April 2012 to April 2013 were enrolled into the ACI group. They were classified with Korean TOAST classification as five subtypes： atherothrombosis （AT） type, small artery disease （SAD） type, cardioembolism （CE） type, stroke of other disease （SOD） type, and stroke of undetermined etiology （SUE） type. The plasma Hcy concentrations in each group and in 60 heathy people who were selected into the control group were measured. Furthermore, the relationship between plasma Hcy concentration and their subtypes were analyzed. Results The plasma Hcy level in ACI group was significant higher than that in the control group （P 〈 0.01）. The levels of plasma Hcy were much higher in patients with AT, SAD, SOD, and CE than those in the control groups （P 〈 0.01）. In different subtypes, AT and SAD subtypes had higher homocysteine concentration than SUD and CE subtypes did. The concentration of Hcy in AT and SAD group had no significant difference. Conclusions ACI is related to hyperhomocysteinemia. The plasma Hcy level varies with different TOAST subtypes of ACI, specially elevating in the subtypes of AT and SAD, which may indicate that hyperhomocysteinemia may increase stroke risk through proatherogenic effect and endothelial dysfunction.