腔隙性脑梗死患者血清Hcy水平与脑动脉血流动力学参数及HDL—C的相关性

Correlation analysis of plasma Hcy level with hemodynamic parameters and high density lipoprotein cholesterol level in patients with lacunar infarction

目的分析腔隙性脑梗死患者血清同型半胱氨酸（Hcy）水平与脑动脉血流动力学参数及高密度脂蛋白胆固醇（HDL-C）的相关性，探讨Hcy在腔隙性脑梗死中的临床意义。方法选择自2012年2月至2013年3月天津市第一中心医院神经内科收治的120例腔隙性脑梗死患者f患者组）以及健康体检的正常人群100例（对照组）为研究对象，采用经颅多普勒（TCD）检测2组研究对象大脑中动脉和基底动脉的收缩血流峰值（SFv）、舒张血流峰值（DRY）、平均血流速度（MFV）和搏动指数（PD，采用循环酶法检测血清Hcy水平，采用酶比色法测定肌酐、总胆固醇、三酰甘油、HDL-C、低密度脂蛋白胆固醇（LDL-C）水平。结果患者组大脑中动脉SFV、DFV、MFV、PI等血流动力学参数均明显高于自身基底动脉及对照组大脑中动脉，差异均具有统计学意义（P〈0．05）；患者组基底动脉MFV、PI等血流动力学参数高于对照组基底动脉，差异有统计学意义（P〈0．05）。患者组Hcy、总胆固醇、LDL-C、三酰甘油、HDL-C水平与对照组比较，差异均有统计学意义（P〈0．05）。直线相关分析显示，腔隙性脑梗死患者大脑中动脉、基底动脉PI与Hcy水平呈正相关关系（r=0．530，p=0．020；r=0．450，P=0．010），HDL-C与Hcy水平之间呈负相关关系（r=-0．308，P=0．010）。结论腔隙性脑梗死患者Hcy水平升高可能促进了远端动脉阻力的增加。

Objective To analyze the correlation of plasma homocysteine （Hcy） level with hemodynamic parameters and high density lipoprotein cholesterol （HDL-C） level in patients with lacunar infarction and its significance in lacunar infarction. Methods Transcranial Doppler examination was performed in 120 patients with lacunar infarction admitted to our hospital from February 2012 to March 2013 and 100 healthy controls; systolic flow velocity （SFV）, distalotic flow velocity （DFV）, mean flow velocity （MFV） and pulsatility index （PI） were assessed at the middle cerebral artery （MCA） and basilar artery （BA）. Serum creatinine, total cholesterol, triglycerides, HDL-C, and low-density lipoprotein cholesterol （LDL-C） levels were detected using enzymatic colorimetric method. Plasma Hcy level was measured by circulating enzymatic method. Results Blood flow velocity indexes, such as SFV, DFV, MFV and PI in the MCA of lacunar cerebral infarction patients, were significantly higher than those in their BA and the MCA blood of control group, with statistically significant differences （P〈0.05）; blood flow velocity indexes, such as MFV and PI in the BA of lacunar cerebral infarction patients, were higher than those in the BA of the control group, with significant differences （P〈0.05）. Lacunar cerebral infarction patients had significantly higher levels of Hey, total cholesterol, LDL-C, triglyceddes, and HDL-C as compared with control group, with statistical differences （P〈0.05）. Linear correlation analysis showed that PI of MCA and BA and Hcy level were positively correlated in lacunar infarction patients （r=0.530, P=-0.020; r=0.450, P=0.010）; and HDL-C and Hcy levels had negative correlation （r=-0.308, P=-0.010）. Conclusion A significant association between plasma Hcy and PI of cerebral arteries and serum HDL-C level indicates that Hcy plays a role in the increase of distal arterial resistance in lacunar infarction.