血浆同型半胱氨酸水平及颈动脉内膜中层厚度与初发脑梗死的相关性研究

The correlation of plasma homocysteine and intima-media thickness with incipient cerebral infarction

目的 探讨血浆同型半胱氨酸（HCY）水平及颈动脉内膜中层厚度（IMT）与初发脑梗死的关系.方法 根据临床诊断标准,对收治的初发脑梗死患者随机选取112例作为脑梗死组,随机选取同期在该院健康体检者102例做为对照组.两组均行颈动脉超声检查,检测颈动脉内膜中层厚度;采用化学发光免疫分析法测定血浆HCY、叶酸、维生素B12等指标.结果 脑梗死组血浆HCY水平[（24.89±1.96） μmol/L]明显高于对照组[（8.58 ±2.34） μmol/L]（P＜0.01）、血清叶酸及维生素B12水平[分别为（4.79±2.35） μg/L和（228.67±114.75） ng/L]低于对照组[分别为（8.65±2.64） μg/L和（320.53±154.78） ng/L]（P＜0.01）;脑梗死组IMT[分别为左颈总动脉叉处（1.12±0.25） mm、右颈总动脉叉处（1.09±0.28） mm、左颈内动脉（1.18±0.23） mm、右颈内动脉（1.03±0.24） mm]明显高于正常对照组[分别为左颈总动脉叉处（0.65±0.18）mm、右颈总动脉叉处（0.61 ±0.24） mm、左颈内动脉（0.58±0.22）mm、右颈内动脉（0.61 ±0.19）mm] （P ＜0.05）.对照组血浆HCY与IMT两者之间无相关性（r=0.081,P＞0.05）,脑梗死组HCY与IMT两者之间呈高度正相关（r =0.834,P＜0.01）.结论 血浆HCY增高及颈动脉内膜中层厚度增厚与初发脑梗死密切相关,联合检测血浆HCY及颈动脉内膜中层厚度对脑梗死的诊断和二级预防具有重要临床意义.

Objective To explore the relationship between the level of plasma homocysteine（HCY）and intima-media thickness（IMT）with incipient cerebral infarction.Methods According to the clinical diagnostic criteria,112 patients with incipient cerebral infarction were randomly selected as the cerebral infarction group,and 102 healthy people were randomly selected as the control group.All carotid arteries of both groups were checked by carotid artery ultrasound and IMT was tested.The levels of plasma HCY and plasma folate as well as vitamin B12 were measured in both groups by chemiluminescence immunoassay.Results The plasma HCY level in the cerebral infarction group [（24.89 ± 1.96） μmol/L] was significantly higher than （8.58 ± 2.34） μmol/L in the control group （P ＜ 0.01）.The levels of plasma folate [（4.79 ± 2.35） μg/L] and vitamin B12 [（228.67 ± 114.75） ng/L] in the cerebral infarction group were significantly lower than [（8.65 ± 2.64） μg/L and （320.53 ± 154.78） ng/L] of the control group （P ＜ 0.01）.The IMT of the cerebral infarction group [respectively the left common carotid artery fork （1.12 ± 0.25） mm,the right common carotid artery fork（1.09 ± 0.28） mm,the left internal carotid artery（1.18 ± 0.23） mm,the right internal carotid artery（1.03 ± 0.24）mm] were obviously higher than those of the control group[respectively the left common carotid artery fork （0.65 ± 0.18） mm,the right common carotid artery fork （0.61 ± 0.24） mm,the left internal carotid artery（0.58 ±0.22）mm,the right internal carotid artery（0.61 ±0.19）mm] （P ＜0.05）.Significant positive correlation between IMT and HCY was found in patients with cerebral infarction（r =0.834,P ＜ 0.01）,but no corre lation was found in the control group（r =0.081,P ＞ 0.05）.Conclusion The increase of plasma HCY and the thickening of IMT are closely related with incipient cerebral infarction.Examination of plasma HCY and IMT has important clinical significance for the secondary prevention of incipient cerebral infarction.