血清Hcy和hs-CRP与缺血性卒中各亚型关系的临床研究

Clinical Study on Correlation between Levels of Serum Homocysteine,High Sensitivity C-reactive Protein and Subtypes of Ischemic Stroke

目的探讨血清同型半胱氨酸(homocysteine,Hcy)、超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)在大动脉粥样硬化型(large artery atherosclerotic,LAA)、小血管闭塞型(small artery occlusion,SAO)缺血性卒中(ischemic stroke,IS)中的差异,以及二者与完全性、进展性卒中的关系。方法入组患者按急性卒中治疗Org 10 172试验(trial of org 10 172 in acute stroke treatment,TOAST)分型分为LAA及SAO卒中共217例,LAA 130例,其中进展性卒中58例;SAO 87例,其中进展性卒中12例。检测并比较血清Hcy和hs-CRP水平。结果 (1)Hcy(P<0.019)、hs-CRP(P=0.021)、低密度脂蛋白(low density lipoprotein,LDL)(P=0.012)在LAA组及SAO组经Logistic回归分析纠正混杂因素后差异显著,LAA组血清Hcy和hs-CRP、LDL显著高于SAO组。(2)Hcy(P<0.001)、hs-CRP(P=0.017)、LAA(P=0.023)在进展性和完全性卒中中纠正混杂因素后比较,差异仍有统计学意义,全部进展性卒中患者血清Hcy、hs-CRP、LAA明显高于完全性卒中患者。(3)LAA组中,进展性与完全性两亚组患者血清Hcy无明显差异,而进展性卒中亚组hs-CRP水平明显高于完全性卒中患者。结论血清Hcy、hs-CRP、LDL是LAA卒中的独立危险因素,血清Hcy和hs-CRP可作为IS病因分型的参考指标之一;高Hcy、hs-CRP、LAA是进展性卒中的独立危险因素。

Objective To investigate the differences of homocysteine（Hcy）,high sensitivity C-reactive protein（hs-CRP） on large-artery atherosclerosis and small vessel occlusive ischemic stroke（IS）,and the association between the two and complete IS and progressive IS.Methods A total of 217 participants with large-artery atherosclerosis（LAA） ischemic stroke（n=130） and small artery occlusive（SAO） ischemic stroke（n =87） based on trial of org 10 172 in acute stroke treatment（TOAST） were recruited in this study.The cases number of progressive stroke（PS） in LAA group and SAO group were 58 and 12 respectively.The level of serum Hcy and hs-CRP contents were measured and compared between two groups.Results （1） Hcy（P〈0.019）,hs-CRP（P=0.021）,and low density lipoprotein（LDL）（P=0.012） were significantly different in the LAA and SAO groups by logistic regression analysis,and the levels of serum Hcy,hs-CRP and LDL in the LAA stroke group were significantly higher than those in the SAO group.（2） There were significant difference in Hcy（P〈0.001）,hs-CRP（P=0.017） and LAA（P=0.023） after correction of mixed factors in progressive and complete stroke,and serum levels of Hcy,hs-CRP and LAA were significantly higher in all patients with progressive stroke than those with completestroke.（3） There were no significant difference in the levels of Hcy between PS and complete stroke in LAA,while the levels of hs-CRP were higher in PS.Conclusion Hcy,hs-CRP and LDL are the independent risk factors of LAA stroke.Hcy,hs-CRP,and LDL can be used as one of the indicators of IS classification.Hcy,hs-CRP and LAA are the independent risk factors of PS.