颈动脉粥样硬化斑块性质与血清总同型半胱氨酸、血脂水平的相关性研究

Correlation between carotid atherosclerotic vulnerable plaque and serum total homocysteine and blood lipid levels

目的探讨颈动脉粥样硬化斑块性质与血同型半胱氨酸(Hcy)、血脂水平的相关性。方法选取50岁以上进行颈部血管超声检查的颈动脉粥样硬化患者269例为研究对象,根据检查结果分为颈动脉粥样硬化稳定斑块组(简称稳定斑块组,106例)、颈动脉粥样硬化易损斑块组(简称易损斑块组,163例)。检测比较两组患者的血清Hcy水平、血脂水平;对影响易损斑块发生的因素进行多因素Logistic回归分析。结果易损斑块组患者的年龄、男性比例、TC、LDL-C、脂蛋白LP(a)、Hcy水平高于稳定斑块组患者,HDL-C水平低于稳定斑块组患者,差异有统计学意义(P<0.05)。易损斑块组患者高同型半胱氨酸血症的比例显著高于稳定斑块组患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄、高Hcy水平、高LP(a)水平是易损斑块发生的危险因素,女性、高HDL-C水平是易损斑块发生的保护因素。结论高龄、高Hcy水平、高LP(a)水平是颈动脉粥样硬化易损斑块发生的独立危险因素,降低Hcy水平对减缓颈动脉粥样硬化的进程可能具有积极的作用。

Objective To investigate the correlation between carotid atherosclerotic vulnerable plaque and blood homocysteine （Hcy） and blood lipid levels. Method A total of 269 patients with carotid atherosclerosis who underwent cervical vascular uhrasonography were selected as subjects. According to the results, the carotid atherosclerotic stable plaque group （SP group, 106 cases） and the carotid atherosclerotic vulnerable plaque group （VP group, 163 cases） were selected. Serum Hcy levels and blood lipid levels were compared between the two groups. Multivariate logistic regression analysis was performed on the factors affecting the occurrence of vulnerable plaque. Results The age, male ratio, TC, LDL-C, lipoprotein（a） , and Hcy levels in the VP group were higher than those in the SP group, and the HDL-C was lower than that in the SP group. The difference was statistically significant （P〈0.05）. The proportion of patients with high homocysteinemia in the VP group was significantly higher than that in the SP group （P〈0.05）. Multivariate logistic regression analysis showed that age, high Hcy level and high LP（a） level were risk factors for vulnerable plaque. Female and high HDL-C levels were protective factors for vulnerable plaque. Conclusion Age, high Hcy level, and high LP（a） levels are risk factors for carotid atherosclerotic vulnerable plaque. HHcy is an independent risk factor for carotid vulnerable plaque formation. Lowering Hcy level reduces carotid atherosclerosis. The process of hardening may have a positive effect.