急性脑梗死病人血同型半胱氨酸水平与短期预后的关系

Study on the relationship between homocysteine level and short-term outcome in acute cerebral infarction patients

目的:探讨急性脑梗死与血同型半胱氨酸水平(Hcy)的相关性。方法:选取脑梗死病人120例,均行颈动脉彩超检查及血Hcy水平和常规生化指标检测。按血管狭窄程度、有无颈动脉硬化斑块、TOAST分型对病人分组,比较颅内动脉狭窄程度、有无颈动脉硬化斑块以及不同类型脑梗死与Hcy水平的关系,并采用改良的Rankin量表(mRS)对神经功能进行评分,分析心脑血管事件、mRS评分与血Hcy水平的相关性。结果:无狭窄组的Hcy水平显著低于狭窄组(P<0.01)。不同狭窄程度高同型半胱氨酸血症(HHcy)发生率差异有统计学意义(P<0.01)。无斑块组的HHcy发生率、Hcy水平均显著低于斑块组(P<0.01)。大动脉粥样硬化(LAA)和心源性脑栓塞(CE)、小动脉闭塞性卒中或腔隙性卒中(SAA)、其他原因所致的缺血性卒中(SOE)和不明原因的缺血性卒中(SUE)各组HHcy发生率差异均无统计学意义(P>0.05),但各组Hcy值比较差异有统计学意义(P<0.01),其中LAA组高于CE组、SAA组、SUE组和SOE组(P<0.05~P<0.01)。随访后,HHcy组心血管事件总发生率高于Hcy正常组(P<0.05);且HHcy组的mRS评分显著高于Hcy正常组(P<0.01)。结论:急性脑梗死颅内动脉狭窄严重程度、TOAST分型、有无颈动脉硬化斑块与血Hcy相关,HHcy是导致脑梗死预后不佳的一种重要因素。

Objective：To study the correlation between homocysteine （ Hcy ） level and acute cerebral infarction. Methods：One hundred and twenty patients with acute cerebral infarction patients were detected using the carotid color ultrasonography,and the Hcy levels and blood routine biochemical indexes in all cases were examined. The patients were divided into two groups according to the degree of vascular stenosis,TOAST classification and carotid atherosclerosis plaque. The correlations between the degree of intracranial artery stenosis,carotid atherosclerosis plaque and cerebral infarction type, and Hcy levels were compared. The never function of the patients was evaluated using the modified Rankin scale （ mRS ） , and the cardiovascular and cerebrovascular events and correlation between mRS score and Hcy level in all cases were analyzed. Results：The level rate of Hcy in non-stenosis group was significantly lower than that in stenosis group（P 〈0. 01）,and the difference of the incidence rate in different degree stenosis patients was statistically significant（P〈0. 01）. The level of high homocysteine（HHcy） and Hcy in non-stenosis group were significantly lower than those in stenosis group（P〈0. 01）. The differences of the incidence rates in large-artery atherosclerosis（LAA）,cardiogenic cerebral embolism（CE）,small arterial occlusive or lacunar stroke（SAA）,stroke of other demonstrated etiology（SOE） and stroke of other undermonstrated etiology（SUE） groups were not statistically significant（P〉0. 05）,the difference of the value of Hcy in each group was statistically significant（P〈0. 01）,and the level of Hcy in LAA group was higher than that in CE,SAA,SUE and SOE groups（P〈0. 05 to P〈0. 01）. The total incidence rate of the cardiovascular event in HHcy group was higher than that in normal Hcy group（P〈0.05）,and the mRS score in HHcy group was significantly higher than that in normal Hcy group（P 〈0. 01）. Conclusions：The intracranial artery stenosis severity,TOAST classification and carotid atherosclerosis plaque are related to the blood Hcy. The HHcy is an important factor leading to the poor prognosis of patients with acute cerebral infarction.