血浆高半胱氨酸水平与大动脉粥样硬化性卒中的相关性：回顾性病例系列研究

Correlation between serum homocysteine levels and large artery atherosclerotic stroke： a retrospective case series study

目的探讨血高半胱氨酸（homocysteine，Hcy）与大动脉粥样硬化性卒中（large artery atherosclerosis，LAA）的关系。方法连续纳入L蛆和小动脉闭塞性卒中（small artery occlusion，SAO）患者，比较人口统计学、基线临床资料以及实验室化验结果。应用多变量logistic回归分析确定L诅的独立危险因素。采用Spearman相关分析血清Hcy浓度与颈动脉斑块积分之间的相关性。结果共纳入117例LAA和SAO患者，LAA组42例，SAO组75例。L蛆组血浆Hcy水平[中位数（四分位间距）][15．35（12．20～20．43）μmol／L对12．40（10．40～15．oo）μmol／L；Z=-2．540，P=0．011]和颈动脉斑块积分[（6．30±4．11）mm对（4．19±2．84）mm；t=2．952，P=0．004]以及处于血浆Hcy水平三分位数分组患者比例（Х^2=10．697，P=0．005）均显著性高于SAO组。多变量logistic回归分析显示，血浆Hcy浓度处于第3三分位数（〉15．3μmol／L）是L诅的独立危险因素（优势比4．739，95％可信区间1．696～13．241；P=0．003）。而且，血清Hcy浓度与颈动脉斑块积分呈显著正相关联系（r=0．245，P=0．008）。结论血浆Hcy水平与颈动脉粥样硬化严重程度呈正相关，血浆Hey〉15．3txmol／L是LAA的独立危险因素。

Objective To investigate the relationship between serum homocysteine （Hcy） and large artery atherosclerosis （LAA）. Meltaods The consecutive stroke patients with LAA and small artery occlusion （SAO） were enrolled. The demographics, baseline clinical data, and laboratory test results were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for LAA. Spearman correlation analysis was used to analyze the correlation between serum Hey concentration and carotid plaque scores. Results A total of 117 patients with LAA and SAO were enrolled, 42 were in the LAA group and 75 were in the SAO group. The plasma Hcy levels （median [ interquartile range] 15.35 [ 12.20- 20.43] b^mol/L vs. 12.40 [ 10. 40 - 15.00] μmol/L; Z = -2. 540, P =0. 011）, the carotid plaque scores （6. 30 ＋4. 11 mm vs. 4. 19 ±2. 84 mm; t =2. 952, P =0. 004）, and the proportion of plasma Hcy level at tertile groups of the patients （2（2 = 10. 697, P =0. 005） of the LAA plasma group were all significantly higher than those of the SAO group. Multivariate logistic regression analysis showed that the plasma Hey concentration was in the third tertile （ 〉 15.3 μmol/L）, and it was an independent risk factor for LAA （odds ratio 4. 739, 95% confidence interval 1. 696- 13.241; P= 0.003）. Moreover, there was a significant positive correlation between the serum Hcy concentration and the carotid plaque scores （r = 0. 245, P = 0. 008）. Conclusions The plasma I-Icy levels were positively correlated with the severity of carotid atherosclerosis. The Hcy 〉 15.3 μmol/L was an independent risk factor for LAA.