血浆同型半胱氨酸水平与中国缺血性卒中亚型关系的研究

Correlation between Chinese ischemic stroke subtype and the levels of plasma homocysteine

目的测定不同病因分型及发病机制急性脑梗死患者血浆同型半胱氨酸(Hcy)的水平,并探讨其与中国缺血性卒中亚型(CISS分型)的关系。方法连续选取在神经内科住院的发病7 d之内的288例ACI患者作为研究组,并选取300例同期健康体检者作为对照组,测定并比较2组血浆Hcy的水平;根据CISS分型将急性脑梗死患者分为大动脉粥样硬化性脑梗死(LAA)、穿支动脉闭塞性脑梗死(PAD)、心源性脑栓塞(CS)、其他病因型缺血性卒中(OE)以及不明原因性缺血性卒中(UE)组,比较5组间Hcy水平;其中,大动脉粥样硬化性脑梗死组依据发病机制不同,进一步分为动脉到动脉栓塞、低灌注/栓子清除下降、载体动脉堵塞穿支动脉及混合机制组,比较各组间Hcy水平。结果急性脑梗死组血浆Hcy水平与健康对照组比较,差异有统计学意义(P<0.05);LAA型、CS型、PAD型、UE型及OE型脑梗死血浆Hcy水平比较,差异均无统计学意义(P>0.05);进一步将LAA型脑梗死患者分为动脉到动脉栓塞、载体动脉堵塞穿支动脉、低灌注/栓子清除下降及混合机制组血浆Hcy水平,组间比较差异均无统计学意义(P>0.05)。结论高Hcy血症可能作为危险因素参与了急性脑梗死的发病过程,但是其在CISS分型各病因分型及不同发病机制患者间的表达水平无明显差异,提示对CISS分型的判定可能无指导意义。

Objective To detect the levels of plasma homocysteine(Hcy)in patients with acute cerebral infarction(ACI)of different etiological types and pathogenesis mechanism,and to explore the correlation between Chinese ischemic stroke subtype(CISS)and the levels of Hcy.Methods A total of 288 patients with ACI were enrolled s ACI group,at the same time,the other 300 healthy subjects were enrolled as control group.The levels of plasma Hcy were detected and compared between the two groups.According to CISS,all the patients were redivided into large artery atherosclerosis cerebral infarction group(LAA group),cardiogenic cerebral embolism group(CS group),perforator artery obliterans cerebral infarction group(PAD group),other causes cerebral infarction group(OE group),uncertain etiological cerebral infarction group(UE group).Moreover the patients in LAA were further divided into the carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group.The levels of Hcy were observed and compared among the groups.Results The levels of Hcy in ACI group were significantly higher than those in control group[(19.82±16.23)μmol/L VS(14.52±4.81)μmol/L,P<0.05].However there were no significant differences in the plasma levels of Hcy among different types of cerebral infarction including LAA,CS,PAD,UE and OE(P>0.05).Moreover there were no significant differences in the plasma levels of Hcy among carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group(P>0.05).Conclusion The Hcy may participate in the pathogenesis of ACI,but its there are no significant differences in the expression levels of Hcy among ACI patients with different etiological types and pathogenesis mechanism,which suggests that the evaluation of CISS may have no directive significanc.