负荷后同型半胱氨酸水平在脑梗死再发缺血性血管事件的随访研究

The follow-up research on the value of the plasma homocystine after methionine loading test on therecurrent ischemic vascular event in cerebral infarction.

目的研究蛋氨酸负荷试验（MLT）后血浆同型半胱氨酸（Hcy）对脑梗死患者再发缺血性血管事件[脑梗死和（或）短暂性脑缺血发作（TIA）、急性冠状动脉综合征、其他血管栓塞]的影响。方法采用高压液相色谱法测定血浆空腹Hcy（FHcy）和负荷后Hcy（PHcy）水平，选取FHcy水平正常的脑梗死患者，MLT后高Hcy血症（PHHcy）组135例和负荷后非高Hcy血症组（NPHHcy）248例，对两组患者随访观察5年内再发缺血性血管事件的情况。结果两组不同性别FHcy、PHcy和PHcy与FHcy水平差值（△Hcy）比较，男性均高于女性（P〈O．05）。PHHcy组5年内发生脑梗死和（或）TIA、急性冠状动脉综合征和总缺血性事件均高于NPHHcy组（P〈O．05）；Logistic回归分析结果显示，PHcy和AHcy是脑梗死再发缺血性血管事件的独立危险因素[优势比（OR）为0．509；95%可信区间（CI）：0．286～0．904，P〈O．053和（OR=2．107；95％CI：1．185～3．745，P〈0．05）。结论PHHcy可能是脑梗死患者再发缺血性血管事件的独立危险因素。

Objective To evaluate the effect of the plasma homocystine （Hcy） after methionine loading test （MLT） on the recurrence of ischemic vascular event, including cerebral infarction, transient ischemic attack （TIA）, acute coronary syndrome, other vascularembolism, in cerebral infarction patients. Methods The fasting plasma homocystine （FHcy） and homocystine after MLT （PHcy） levels were measured by high-performance liquid chromatography. 383 cerebral infarction patients with normal Hcy level were selected and divided into hyperhomocysteinemia after MLT （PHcy） group （n=135） and non-hyperhomocysteinemia after MLT （NPHcy） （n=248）. Recurrence rates of ischemic vascular events within a 5-years follow-up period was observed. Results The levels of FHcy, PHcy and △Hcy （PHcy level subtracted FHcy level） were higher in males than in females in the two groups （all P〈0.05）. The recurrence rates of cerebral infarction/TIA, acute coronary syndrome and other vascular embolism events were higher in PHcy group than in NPHcy group within the follow-up period （all P〈0.05）. By forward stepwise logistic analysis, we found that the increased PHcy and AHcy levels were the independent risk factors for recurrent ischemic vascular events [odds ratio （OR） ： 0. 509, 2. 107, 95 % confidence interval （CI） ： 0. 286-0. 904,1. 185-3. 745, both P〈0.05）. Conclusions PHHcy may be an independent risk factor for recurrence ischemic vascular events in cerebral infarction.