血清同型半胱氨酸、血糖三项水平与H型高血压患者发生急性脑梗死的关联性研究

The correlation between levels of serum homocysteine,three indexes of blood glucose and acute cerebral infarction in patients with type H hypertension

目的探讨血清同型半胱氨酸(Hcy)、空腹血糖(FPG)、2 h口服葡萄糖耐量试验(2 h OGTT)、糖化血红蛋白(HbA1c)水平与H型高血压患者发生急性脑梗死(ACI)的关联性。方法120例H型高血压患者,其中34例发生ACI(ACI组),其余86例为对照组。测定血清Hcy、FBG、2 h OGTT、HbA1c水平,分析与ACI发生的关联性及与ACI患者梗死灶大小、TOAST分型、美国国立卫生研究院卒中量表(NIHSS)评分的关系。结果ACI组合并T2DM占比、收缩压(SBP)、舒张压(DBP)及血清Hcy、FBG、2 h OGTT、HbA1c水平高于对照组(P<0.05)。合并T2DM、SBP、DBP、血清Hcy、FBG、2 h OGTT、HbA1c均为H型高血压患者发生ACI的独立危险因素(P<0.05)。血清Hcy、FBG、2 h OGTT、HbA1c水平比较,梗死灶直径>4 cm患者高于≤4 cm患者,大动脉粥样硬化(LAA)型患者高于小动脉闭塞(SAO)型患者,NIHSS评分1~4分患者低于5~15分及16~42分患者(P<0.05)。结论血清Hcy、血糖三项水平升高均为H型高血压患者发生ACI的独立危险因素,ACI以LAA型为主,且Hcy、血糖三项水平与患者梗死灶大小、TOAST分型、神经功能缺损程度有关。

Objective To investigate the association of levels of serum homocysteine(Hcy),fasting plasma glucose(FPG),2 h oral glucose tolerance test(2 h OGTT),and glycosylated hemoglobin(HbA1c)with acute cerebral infarction(ACI)in patients with type H hypertension.Methods A retrospective study was conducted on 120 patients with type H hypertension.In the patients,34 patients with ACI were included in ACI group,and remaining 86 patients were included in the control group.Levels of serum Hcy,FBG,2 h OGTT and HbA1c were determined after confirmed diagnosis of type H hypertension,and their correlation with ACI,infarct size,TOAST typing and National Institutes of Health Stroke Scale(NIHSS)score of patients with ACI was analyzed.Results The proportion of patients with T2DM,systolic blood pressure(SBP),diastolic blood pressure(DBP),levels of serum Hcy,FBG,2 h OGTT and HbA1c in the ACI group were significantly higher than those in the control group(P<0.05).Logistic multivariate analysis showed that T2DM,SBP,DBP,serum Hcy,FBG,2 h OGTT,and HbA1c were considered as risk factors for ACI(P<0.05).Levels of serum Hcy,FBG,2 h OGTT,and HbA1c were significantly higher in patients with infarct diameter>4 cm than in those with infarct diameter≤4 cm.The levels of Hcy,FBG,2 h OGTT and HbA1c in patients with large artery atherosclerosis(LAA)were significantly higher than those in patients with small artery occlusion(SAO).Levels of Hcy,FBG,2 h OGTT and HbA1c in patients with NIHSS scores of 1~4 were lower than that of 5~15 and 16~42(P<0.05).Conclusion The elevated levels of serum Hcy and three items of blood glucose are risk factors for ACI in patients with type H hypertension.The ACI is mainly LAA type,and they are related to the infarct size,TOAST typing and the degree of neurological deficit in patients with ACI.