血浆同型半胱氨酸与缺血性脑血管病患者颈动脉粥样硬化斑块的关系

Relationship between plasma homocysteine and carotid atherosclerotic plaques in patients with ischemic cerebrovascular disease

目的分析血浆同型半胱氨酸(Hcy)与缺血性脑血管病患者颈动脉粥样硬化斑块的关系。方法选取36例缺血性脑血管病患者作为研究对象,利用颈动脉彩色多普勒超声对患者颈动脉内-中膜厚度(IMT)进行检查,并对患者Hcy浓度进行测定,比较不同颈动脉病变程度患者和不同斑块易损性质患者的血浆Hcy水平及高同型半胱氨酸血症(HHcy)发生情况,并对颈动脉粥样斑块形成的影响因素进行Logistic回归分析。结果颈动脉超声检查显示IMT正常、增厚以及斑块形成患者分别有10、6、20例,IMT增厚以及斑块形成患者的Hcy水平及HHcy发生率均明显高于IMT正常患者,差异具有统计学意义(P<0.05);斑块形成患者Hcy水平明显高于IMT增厚患者,差异具有统计学意义(P<0.05);但斑块形成患者HHcy发生率与IMT增厚患者比较差异无统计学意义(P>0.05)。20例斑块形成患者中易损斑块8例,非易损斑块12例;易损斑块患者Hcy水平(28.95±2.37)μmol/L及HHcy发生率100.00%均明显高于非易损斑块患者的(23.46±1.82)μmol/L和58.33%,差异具有统计学意义(P<0.05)。经多因素Logistic回归分析可知,血脂异常、高血压、糖尿病、年龄、高Hcy水平、吸烟是影响颈动脉粥样斑块形成的危险因素(P<0.05)。结论缺血性脑血管病患者伴发HHcy更容易导致颈动脉粥样硬化斑块,HHcy可以视作其独立的危险因素。

Objective To analyze the relationship between plasma homocysteine(Hcy)and carotid atherosclerotic plaques in patients with ischemic cerebrovascular disease.Methods A total of 36 patients with ischemic cerebrovascular disease were selected as research objects,carotid artery color doppler ultrasound was used to examine the carotid artery intima-media thickness(IMT),the concentration of Hcy in patients was measured.The plasma Hcy level and occurrence of hyperhomocysteinemia(HHcy)between patients with different degrees of carotid artery disease and vulnerable plaque were compared.Logistic regression analysis was used to analyze the influencing factors of carotid atherosclerotic plaque formation.Results Carotid ultrasonography showed that there were 10,6 and 20 cases of IMT normal,thickening and plaque formation respectively,the level of Hcy and the incidence of HHcy in patients with IMT thickening and plaque formation were significantly higher than those in normal IMT patients,the differences were statistically significant(P<0.05).The level of Hcy in patients with plaque formation was significantly higher than that in patients with IMT thickening,the difference was statistically significant(P<0.05),but the incidence of HHcy in patients with plaque formation was not significantly different from that in patients with IMT thickening(P>0.05).In 20 patients with plaque formation,8 cases were vulnerable plaque and 12 were non-vulnerable plaque.The level of Hcy and the incidence of HHcy in vulnerable plaque patients were(28.95±2.37)μmol/L and 100.00%,which were significantly higher than(23.46±1.82)μmol/L and 58.33%in non-vulnerable plaque patients,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that dyslipidemia,hypertension,diabetes mellitus,age,high Hcy level and smoking were risk factors for carotid atherosclerotic plaque formation(P<0.05).Conclusion Ischemic cerebrovascular disease patients complicated with HHcy is more likely to lead to carotid atherosclerotic plaque,HHcy can be regarded as an independent risk factor.