血同型半胱氨酸水平与急性脑梗死患者CISS分型的关系及护理干预对预后的影响

The Relationship Between Homocysteine Levels and CISS Classification and the Effect of Nursing Intervention on the Prognosis of Patients with Acute Cerebral Infarction

目的 对急性脑梗死患者的血同型半胱氨酸（homocysteine,Hcy）水平进行分析,研究Hcy水平与急性脑梗死的CISS病因分型及护理干预对Hcy及预后的影响,为降低卒中风险提供依据.方法 回顾性分析2014年9月—2016年7月在中国医科大学附属第四医院神经内科确诊的251例急性脑梗死患者的临床资料,对急性脑梗死患者进行CISS病因分型及发病机制分析;同时观察接受护理干预的178例患者和未接受护理干预的73例患者入院时和3个月时血清Hcy的水平,并用改良Rankin量表评分即mRS评分评估3个月时神经功能结局,mRS≤2分为预后良好,3～6分为预后不良.结果 251例急性脑梗死患者中,大动脉粥样硬化性（LAA）133例,穿支动脉疾病（PAD）72例,心源性（CS）16例,其他病因（OE）13例,病因不确定（UE）17例.其中LAA包括主动脉弓粥样硬化2例及颅内/外大动脉粥样硬化131例.LAA型血清Hcy水平高于其他四个亚型,差异有统计学意义（P〈0.05）,其他四个亚型之间Hcy水平差异无统计学意义（P〉0.05）.其中颅内/外大动脉粥样硬化性患者按发病机制分为4种亚型,各亚型间Hcy水平差异无统计学意义（P〉0.05）.发病3个月时,护理干预组预后良好患者比例较高,与未护理干预组比较差异有统计学意义（P〈0.05）.未护理干预组Hcy水平较护理干预组升高,两组间差异有统计学意义（P〈0.05）.结论 血Hcy水平与急性脑梗死CISS病因分型密切相关,并且护理干预影响Hcy水平及短期预后.

Objective To provide evidence for reducing risk of the stroke, homocysteine （Hcy） levels were analyzed to study the relationship between Hcy levels and CISS （Chinese ischemic stroke subclassification） etiology and the effect of nursing intervention was explored on the prognosis of patients with acute cerebral infarction. Methods 251 acute cerebral infarction patients diagnosed in the Fourth Affiliated Hospital of China Medical University from September 2014 to July 2016 were retrospectively analyzed. The CISS was used to classify acute cerebral infarction and analyze the pathogenesis. In the meanwhile, the level of Hcy were measured in 178 patients with nursing intervention and 73 patients The modified Rankin score or the mRS score was without nursing intervention after three months of prognosis. used to evaluate neurological outcomes at 3 months, mRS≤2 was scored as a good prognosis, 3 to 6 was scored as poor prognosis. Results Among 251 patients with acute cerebral infarction, there were 133 cases of aortic atherosclerosis （LAA）, 72 cases of perforator artery disease （PAD）, 16 cases of cardiogenic stroke （CS）, 13 cases of other etiology （OE） and 17 cases of undetermined etiology （UE）. Among them, LAA included 2 patients of aortic arch atherosclerosis and 131 patients of intracranial/external atherosclerosis. The level of Hcy in LAA group was significantly higher than that in the other four subtypes （P 〈 0.05）. There was no significant difference in the levels of Hcy between the other four subtypes （P 〉 0.05）. Also, patients with intracranial/external atherosclerosis were divided into four subtypes according to the pathogenesis and there was no significant difference in the levels of Hcy between the subtypes of LAA （P 〉 0.05）. At the 3 months of onset, the proportion of patients with good prognosis in the nursing intervention group was higher, and the difference was significant compared with the untreated nursing group （P 〈 0.05）. There was a significant difference in Hcy level between the two groups （P 〈 0.05）. Conclusion The CISS etiology is related to the level of serum Hcy and nursing intervention affected the level of Hcy and the poor short-term prognosis of acute cerebral infarction.