血浆同型半胱氨酸水平与伴主动脉弓斑块隐源性脑卒中的相关性

Correlation between plasma homocystein level and cryptogenic ischemic stroke in patients with aortic plaques

目的分析血浆同型半胱氨酸(homocystein,Hcy)水平与隐源性缺血性脑卒中(cryptogenic ischemic stroke,CIS)的关系,探讨Hcy水平对CIS的临床意义。方法连续入组2016年1月3日-2017年3月5日在本院神经内科住院的CIS患者和在门诊就诊的健康查体人群(正常对照),检测血浆Hcy水平,行头颈部血管超声、主动脉弓超声评价斑块情况。结果共收集CIS患者32例,正常对照47例。CIS患者血浆Hcy水平中位数高于正常对照(21.83μmmol/L vs 15.73μmmol/L,P=0.005),但多元logistic回归分析表明Hcy水平不是CIS发生的独立危险因素;分层分析后发现Hcy水平是伴主动脉弓斑块CIS的独立危险因素(OR=1.55,95%CI:1.53~1.57,P=0.023)。结论 Hcy水平与CIS存在一定相关性,尤其伴有主动脉弓斑块的CIS患者,应注意监测和控制Hcy水平。

Objective To evaluate the association between plasma homocystein（Hcy） level and cryptogenic ischemic stroke（CIS）, and analyze its clinical significance. Methods Patients with CIS and normal controls were consecutively recruited in the ward neurological department and outpatient department of Beijing Shijingshan Hospital to measure their plasma Hcy level by fluorescence polarization immunoassay and the severity of atherosclerotic plaques in carotid arteries and aortic arches were evaluated by ultrasonography. Results Thirty-two CIS patients and 47 normal controls were collected in total. The plasma Hcy level of CIS patients was significantly higher than that of normal controls [21.83 vs 15.73, P=0.005]. Whereas, Hcy level failed to demonstrate an independent association with CIS after adjustment of confounding risk factors in multivariate logistic regression. Then all subjects were stratified by the presence of aortic or carotid plaques respectively. Then, plasma Hcy level was found to be an independent risk factor for CIS patients with aortic plaques（OR=1.55, 95%CI： 1.53-1.57, P=0.023） after adjusting confounding risk factors. Conclusion Hcy level shows association with CIS although Hcy level does not seem to be an independent risk factor for CIS; it is valuable to measure and control plasma Hcy level particularly in CIS patients with aortic plaques.