血清高敏C反应蛋白、同型半胱氨酸与大脑中动脉斑块内出血的关系

Relationship of the serum levels of high sensitivity C-reactive protein and homocysteine with middle cerebral artery intraplaque hemorrhage

目的探讨血清高敏C反应蛋白（hs—CRP）、同型半胱氨酸（Hcy）与大脑中动脉斑块内出血的关系。方法检测63例大脑中动脉主于M1段高度狭窄（狭窄率≥70％）患者（分为症状组与无症状组，斑块内出血组与斑块内无出血组）血清hs—CRP、Hey。所有患者均行常规MRI及高分辨MRI（HR—MRI）检查，分析hs—CRP、Hcy浓度水平与大脑中动脉斑块内出血的相关性。结果症状组37例，无症状组26例。症状组斑块内出血发生率15例（40．5％）高于无症状组3例（11．5％），两者差异有统计学意义（x^2=6．29，P〈0．05）。症状组[hs—CRP（8．97±3．36）mg／L，Hcy（20．00±3．16）μmol／L3高于无症状组[hs—CRP（5．26±3．12）mg／L，Hcy（12．22±1．88）μmol／L3，两者差异均有统计学意义（t=4．43、11．23，P〈0．001）。斑块内出血组（18／63）hs—CRP（10．53±3．59）mg／L，Hcy（21．70±2．40）μmol／L高于斑块内无出血组（45／63）hs—CRP（6．20±3．02）mg／L，Hcy（11．77±1．69）μmol／L，两者差异均有统计学意义（t=4．87、18．58，P〈0．001）。hs—CRP、Hcy浓度水平与大脑中动脉斑块内出血风险呈正相关（r=0．461、0．519，P〈0．001）。结论血清hs—CRP、Hey水平与大脑中动脉斑块内出血关系较密切，可较好地评估斑块的稳定性；大脑中动脉斑块内出血可能增加同侧大脑中动脉供血区急性脑梗死风险。

Objective To investigate the relationship of the serum levels of high sensitivity C- reactive protein（hs-CRP） and homocysteine with middle cerebral artery（MCA） intraplaque hemorrhage. Methods A total of 63 patients who met the inclusion criteria showed high-grade （≥ 70 %）MCA stenosis. The levels of serum hs-CRP and Hey were detected. All patients were divided into symptomatic group and asymptomatic group, intraplaque hemorrhage group and nomintraplaque hemorrhage group. All patients performed conventional MRI and high-resolution MRI（HR-MRI）. The correlation of the serum levels of hs-CRP and homocysteine with middle cerebral artery intraplaque hemorrhage was analyzed. Results Totally 37 symptomatic and 26 asymptomatic MCA stenoses were analyzed. The occurrence rate of intraplaque hemorrhage was significantly higher in symptomatic MCA stenosis group than in asymptomatic MCA stenosis group （40.5 % vs. 11.5%, Z2 = 6.29, P〈 0.05 ）. Symptomatic group displayed a higher hs-CRP and Hey levels （ 8.97 ± 3.36 mg/L and 20.00± 3.16 μmol/L, respectively） than did asymptomatic group（（5.26 ±3.12） mg/L and（ 12.22± 1.88）μmol/L, t= 4.43 and 11.23, respectively, each P 〈 0. 0013 ]. The hs-CRP and Hcy levels were higher in intraplaque hemorrhage group [（ 10.53± 3.59 ） mg/L and （ 21.70 ±2.40 ） μmol/L, respectively] than in nonintraplaque hemorrhage group （ （ 6.20 ± 3.02 ） mg/L and （ 11.77± 1.69 ） μmol/L, t = 4.87 and 18.58, respectively,each P〈0. 0013. The hs-CRP and Hcy levels were positively correlated with the risk for middle cerebral artery intraplaque hemorrhage（r= 0.461 and 0.519, each P〈0. 001 ）. Conclusions The serum levels of hs-CRP and Hey are closely associated with middle cerebral artery intraplaque hemorrhage, which can be used to evaluate the stability of plaque. The MCA intraplaque hemorrhage is associated with ipsilateral stroke.