高同型半胱氨酸血症对急性脑梗死患者预后的影响

Influence of homocysteinemia on prognosis of patients with acute cerebral infarction

目的探讨高同型半胱氨酸血症与急性脑梗死患者预后的相关性,明确血清同型半胱氨酸(Hcy)检查在脑梗死预后评估中的价值。方法对照组取182例正常体检者,测其Hcy水平。选择发病72 h内住院诊治的急性脑梗死病例214例作为急性脑梗死组(ACI组),按照入院Hcy水平分为正常Hcy组和高Hcy组,分别在治疗前、治疗2周及24周检测Hcy,同时评价其临床神经功能损害程度,对Hcy水平及NIHSS、BI结果进行比较分析。结果 1高Hcy脑梗死组与正常Hcy组相比,其心脑血管事件再发率明显升高,NIHSS也升高明显,而BI降低,2组间差异显著。治疗后其NIHSS较治疗前均降低,BI均升高,治疗24周较治疗2周改变更显著。2与对照组比较,ACI组Hcy明显升高,治疗后较治疗前均有降低,治疗24周较治疗2周降低更显著。3ACI组NIHSS评分在治疗2周后较治疗前明显降低,BI无明显差异;治疗24周后,NIHSS较治疗前和治疗2周后均降低,BI较治疗前和治疗2周后均明显升高,差异均有统计学意义。4相关性分析显示,NIHSS评分与Hcy水平呈正相关(r=0.87,P<0.05),BI评分与Hcy呈负相关(r=-0.79,P<0.05)。结论血浆Hcy水平与急性脑梗死的预后密切相关,定期检测Hcy对评估其预后很有价值。

Objective To investigate the correlation between Homocysteinemia and the prognosis of acute cerebral infarction（ ACI） patients,and evaluate the role of homocysteine（ Hcy） test in the assessment of prognosis in ACI patients.Methods 182 normal healthy examine subjects were recruited as control group. 214 cases of ACI within 72 hours after onset were enrolled as ACI group,and divided into normal Hcy group and high Hcy group according to their Hcy level.The levels of Hcy were tested before the treatment,2 weeks and 24 weeks after treatment. NIHSS and BI were employed to evaluate neurological impairment. The results were compared among the three groups. Results ① The recurrence rate of cardiocerebrovascular events and NIHSS score in high Hcy group increased significantly but BI score decreased when compared with the normal Hcy group,there were significant difference between two groups. After 2 weeks of treatment,NIHSS of both groups were lessened while BI increased,24 weeks of treatment achieved more obvious effect. ② Hcy level was obviously higher in ACI group as compared with the control group,which decreased after the treatment,and 24 weeks of treatment was more effectively than 2 weeks of treatment.③ In ACI group,NIHSS were significantly decreased but BI did not change after 2 weeks of treatment; NIHSS at 24 weeks after the treatment was lower than those before the treatment and 2 weeks of treatment later. BI score was significantly increased.④ The correlation analysis showed that Hcy level was positively correlated with NIHSS score（ r = 0. 87,P〈0. 05）,and negatively correlated with BI score（ r =- 0. 79,P〈0. 05）.Conclusion The levels of Hcy associate closely with the prognosis of ACI,and the regularly test of Hcy is very valuable for the assessment of the prognosis of ACI patients.