血清同型半胱氨酸水平对首发急性脑梗死患者短期预后的影响

The influence of serum level of homocysteine on short term prognosis of patients with acute cerebral infarction

目的探讨同型半胱氨酸(Hcy)水平对首发急性脑梗死(ACI)患者短期预后的影响。方法 90例首发ACI患者与90例健康志愿者分成ACI组和对照组,检测其Hcy、内皮型一氧化氮合酶(e NOS)、一氧化氮(NO)、颈动脉内膜中层厚度(IMT)和血管内径变化率(FMD)等指标,另将90例ACI患者分为干预Ⅰ组(45例)和干预Ⅱ组(45例),干预Ⅰ组常规治疗,干预Ⅰ组给予维生素B12和B9辅助Hcy代谢。治疗后观察Hcy、IMT、FMD、e NOS、NO,并对数据进行统计学分析。结果与对照组治疗后比较,ACI组的Hcy、IMT和FMD明显升高,e NOS、NO明显降低,两组之间差异具有显著性(P<0.05)。治疗前,干预Ⅰ组和干预Ⅱ组患者间血清Hcy、NIHSS评分和BI评分无显著差异,治疗后2周至6周,干预Ⅰ组患者的血清Hcy显著改善,神经功能逐步恢复,明显优于干预Ⅱ组,差异具有显著性(P<0.05)。结论血清Hcy水平与ACI患者的发病和预后有密切联系,可在常规治疗的基础上给予维生素B辅助Hcy代谢。

Objective To explore the influence of serum level of homocysteine on short term prognosis of patients with acute cerebral in-farction. Methods A total of 90 patients with acute cerebral infarction and 90 healthy volunteers in this hospital were allocated in this study. In-dexes such as Hcy,eNOS,NO,IMT and FMD were examined and compared. 90 patients with ACI were divided into treatment groupⅠand treat-ment groupⅡ,patients in treatment group I were treated with vitamin B12 and vitamin B9. The efficacy of treatment was evaluated according to the standard,and the data were statistically analyzed. Results Comparison with the control group after treatment,ACI group Hcy,IMT and FMD in-creased significantly,eNOS,NO significantly reduced,there was significantly difference（ P ﹤0. 05）. Before treatment,the levels of serum Hcy, NIHSS score and BI scores in groupⅠand groupⅡwere no significant differences. After 2 and 6 weeks treatment,the levels of Hcy in group I was significantly improved,neurological function gradually restored,much better than the intervention group Ⅱ（ P ﹤0. 05）. Conclusion Serum level of homocysteine is closely correlated to pathogenesis and prognosis of patients with ACI,and they can be treated with vitamin B on the basis of conventional treatment.