颈部血管超声与同型半胱氨酸检测在脑梗塞合并颈动脉狭窄病变的临床应用价值

Clinical Value of Neck Vascular Ultrasound and Homocysteine Level in Patients With Cerebral Infarction and Carotid Stenosis

目的：探讨颈部血管超声与血清同型半胱氨酸（Homocysteine, Hcy）在脑梗塞颈动脉狭窄病变的临床应用价值。 方法：2012-01至2013-12选取115例脑梗塞患者为脑梗塞组，另选取110例健康体检者为对照组，采用血管超声测定各组颈动脉狭窄情况（无狭窄者：狭窄率为0；轻度狭窄者：狭窄率≤29％；中度狭窄者：狭窄率为30％~69％；重度狭窄者：狭窄为70％~99％；完全闭塞者：狭窄为100%）、斑块形成情况及颈总动脉内中膜厚度（Intima-media thickness, IMT）。采用循环酶法测定两组血清Hcy，采用日立全自动化生化分析仪测定两组甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平。 结果：脑梗塞组颈动脉血管狭窄发生率高于对照组（89.56％ vs 10.91％），差异有统计学意义（P〈0.001）。脑梗塞组与对照组比，斑块发生率（73.91％ vs 6.08％）、IMT水平[（1.85±0.42）mm vs（0.75±0.21）mm]、Hcy水平[（42.32±12.02）μmol/L vs（6.32±2.45）μmol/L]、高Hcy血症发生率（71.30％ vs 3.63％）、甘油三酯[（4.25±1.12）mmol/L vs（1.63±0.74）mmol/L]、低密度脂蛋白胆固醇水平[（5.96±1.36）mmol/L vs（2.32±0.82） mmol/L]均明显增高，两组比较差异均有统计学意义（P均〉0.05）。脑梗塞组患者中根据狭窄程度进一步分析可见，完全闭塞者、重度狭窄者的斑块发生率、IMT水平、血清Hcy水平、高Hcy血症发生率、甘油三酯、低密度脂蛋白胆固醇水平均高于轻、中度狭窄者，差异均有统计学意义（P〈0.05）。经Logistic分析可知，IMT水平、血清Hcy水平、低密度脂蛋白胆固醇为脑梗塞颈动脉狭窄的独立危险因素。 结论：脑梗塞合并颈动脉狭窄病变患者血清Hcy水平显著升高，且血清Hcy水平与颈动脉狭窄程度相关。

Objective：To investigate the clinical value of neck vascular ultrasound and homocysteine （Hcy） level in patients with cerebral infarction and carotid stenosis. Methods： Our research included 2 groups. Cerebral infarction group, n=115 patient who were treated in our hospital from 2012-01 to 2013-12, and Control group, n=110 healthy subjects from physical check-up. Neck vascular ultrasound was conducted to classify the degree of carotid stenosis as ①no stenosis, ②mild degree, the stenosis rate≤29%, ③moderate degree, the stenosis rate at 30%~69%,③severe degree, the stenosis rate at 70%~99%,④complete occlusion. Carotid plaque formation and vascular intima-media thickness （IMT） were examined by neck ultrasound. Blood levels of Hcy and triglyceride （TG）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） were measured in clinical laboratory. Results： Compared with Control group, Cerebral infarction group had the higher rate of carotid stenosis 89.56%vs 10.91%, more plaque formation 73.91%vs 6.08%and increased IMT （1.85 ± 0.42） mm vs （0.75 ± 0.21） mm;higher blood levels of Hcy （42.32 ± 12.02） μmol/L vs （6.32 ± 2.45） μmol/L and higher rate of high blood Hcy syndrome 71.30%vs 3.63%;higher levels of TC （4.25 ± 1.12） mmol/L vs （1.63 ± 0.74） mmol/L and LDL-C （5.96 ± 1.36） mmol/L vs （2.32 0.82） mmol/L, P〈0.05. In Cerebral infarction group, the patients with complete carotid occlusion and severe stenosis had the higher rate of plaque formation and increased IMT;higher levels of Hcy and more high blood Hcy syndrome;higher levels of TG and LDL-C than the patients with mild and moderate carotid stenosis, P〈0.05. Logistic analysis indicated that the levels of IMT, Hcy and LDL-C were the independent risk factors for cerebral infarction and carotid stenosis. Conclusion： The patients with cerebral infarction and carotid stenosis have obviously increased blood level of Hcy. Hcy may predict various degree of carotid stenosis in relevant patients.