高龄急性脑梗死患者同型半胱氨酸与颈动脉硬化的相关性

Correlation of homocysteine with carotid atherosclerosis in elderly patients with acute cerebral infarction

目的探讨高龄急性脑梗死（acute cerebral infarction,ACI）患者同型半胱氨酸（homocysteine,Hcy）与颈动脉硬化及预后的相关性。方法选取初发性高龄ACI患者118例和同期健康体检者118例,观察其临床特征、血清Hcy水平的变化及颈动脉粥样硬化情况。将高龄ACI患者又分为不稳定性斑块、稳定性斑块和无斑块组;根据血清Hcy水平,分为Hcy〉10μmol/L组和Hcy≤10μmol/L组;以改良Rankin量表（modified Rankin scale,m RS）评分,将患者分为预后不良和预后良好组。应用Logistic回归分析脑梗死不良预后的危险因素,Spearman相关分析血清Hcy与美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）、m RS及颈动脉内-中膜厚度（intima-media thickness,IMT）的相关性。结果脑梗死组血清Hcy水平及IMT均高于对照组[（19.24±7.86）μmol/L vs（9.12±3.60）μmol/L;（1.27±0.23）mm vs（0.68±0.14）mm,P10μmol/L组入院第1、90天的NIHSS评分、m RS评分〉2分比率和IMT均高于Hcy≤10μmol/L组（P〈0.05）。预后不良组血清Hcy水平及IMT均高于预后良好组[（25.63±10.58）μmol/L vs（12.18±4.40）μmol/L;（1.39±0.32）mm vs（1.14±0.16）mm,P〈0.01]。Logistic回归分析显示,高Hcy（OR=1.346,95%CI：1.163-1.541,P=0.02）、IMT（OR=2.094,95%CI：1.251-3.728,P=0.02）及NIHSS评分（OR=1.443,95%CI：1.176-1.752,P=0.00）是预后不良的独立危险因素。相关分析显示,血清Hcy与NIHSS、m RS及IMT均呈正相关（r=0.538,P=0.04;r=0.514,P=0.05;r=0.726,P=0.00）。结论血清Hcy与NIHSS、m RS及IMT具有良好的相关性,高Hcy可促进高龄急性脑梗死患者颈动脉粥样硬化的发生且患者预后较差。

Objective To investigate the correlation of homocysteine（Hcy）level with carotid atherosclerosis andprognosis in the elderly patients with acute cerebral infarction（ACI）patients. Methods A total of 118 elderly patients withfreshly-diagnosed ACI and 118 healthy people were recruited in this study. Their clinical characteristics,serum level of Hcyand carotid atherosclerosis were observed. Elderly patients with ACI divided into unstable plaque, stable plaque and nonplaque groups. According to the serum Hcy levels, divided into Hcy 〉10 μmol/L group and Hcy≤ 10 μmol/L group. Withmodified Rankin scale（m RS） score, divided the patients into poor prognosis and good prognosis groups. Logistic regressionanalysis was used to analyze the risk factors for poor prognosis of cerebral infarction,and Spearman correlation analysis wasadopted for the correlation of serum Hcy level with the National Institutes of Health Stroke Scale（NIHSS）,m RS and carotidintima-media thickness（IMT）. Results The serum level of Hcy and IMT were significantly higher in the ACI group than thecontrol group[（19.24±7.86）μmol/L vs（9.12±3.60）μmol/L;（1.27±0.23）mm vs（0.68±0.14）mm,P0.01]. The patients withunstable plaques[（24.10±10.26）μmol/L and（1.46±0.37）mm] or stable plaque group[（20.13±7.31）μmol/L and（1.31±0.32）mm] had significantly higher serum Hcy levels and IMT than those without plaque[（12.35±4.32）μmol/L and（1.02±0.21）mm]. What＇s more,IMT was significantly higher in the patients with unstable plaques than those with stable plaques[（1.46±0.37）mm vs（1.31±0.32）mm,P〈0.05]. The patients with Hcy〉10 μmol/L had significantly higher NIHSS scores on the 1stand90 thdays after admission,larger proportion of m RS score 〉2,and increased IMT when compared with those with Hcy ≤1 μmol/L（P〈0.05）. The serum Hcy level and IMT were significantly higher in the patients of adverse prognosis than those of good prognosis（[25.63±10.58）μmol/L vs（12.18±4.40）μmol/L;（1.39±0.32）mm vs（1.14±0.16）mm,P〈0.01]. Logistic regressionanalysis showed that high Hcy（OR=1.346,95%CI： 1.163-1.541,P=0.02）,IMT（OR=2.094,95%CI： 1.251-3.728,P=0.02）and NIHSS score（OR=1.44 3,95%CI： 1.176-1.752,P=0.00）were independent risk factors for poor prognosis. Correlationanalysis showed that serum Hcy level was positively correlated with NIHSS score,m RS score and IMT（r=0.538,P=0.04;r=0.514,P=0.05;r=0.726,P=0.00）. Conclusion The serum level of Hcy has a good correlation with NIHSS,m RS and IMT.High Hcy can promote the occurrence of carotid atherosclerosis and lead to poor prognosis in elderly ACI patients.