同型半胱氨酸与脑梗死及颈动脉斑块的关系研究

Study on the correlation between homocysteine and cerebral infarction&carotid artery plaque

目的研究血清同型半胱氨酸(Hcy)与脑梗死及颈动脉斑块形成的关系,为脑梗死及颈动脉斑块形成的预防及治疗寻求理论依据。方法选取石家庄长城中西医结合医院2014年12月—2018年12月收治的急性脑梗死住院患者120例为脑梗死组,在门诊健康体检健康者70例为对照组。脑梗死组根据颈动脉彩超检查结果分为脑梗死斑块组(又分为稳定斑块组和易损斑块组)及脑梗死无斑块组。记录所有研究对象性别、年龄,测量血压,抽取晨起空腹静脉血测定Hcy、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、尿酸(SUA)水平。比较脑梗死组与对照组、脑梗死斑块组与脑梗死无斑块组上述各指标的差异,对稳定斑块组和易损斑块组血清Hcy水平进行比较,Logistic回归分析各指标与脑梗死及脑梗死颈动脉斑形成的关系。结果与对照组比较,脑梗死组SBP及Hcy、FPG、TG、TC、LDL-C、SUA水平均明显升高(P均<0.05),HDL-C水平明显降低(P<0.05),2组ApoA1、ApoB水平比较差异均无统计学意义(P均>0.05)。与脑梗死无斑块组比较,脑梗死斑块组SBP及Hcy、FPG、TG、TC、LDL-C水平均明显升高(P均<0.05),HDL-C水平明显降低(P<0.05),2组ApoA1、ApoB、SUA水平比较差异均无统计学意义(P均>0.05)。易损斑块组血清Hcy水平明显高于稳定斑块组(P<0.05)。血清Hcy水平是脑梗死的影响因素(OR=1.17,P<0.05),也是脑梗死患者颈动脉斑块形成的影响因素(OR=4.67,P<0.05)。结论高Hcy血症是脑梗死及颈动脉斑块形成的独立危险因素;Hcy水平增高可间接反映颈动脉斑块性质,其水平越高颈动脉斑块稳定性越差。

Objective It is to study the correlation between homocysteine and cerebral infarction and the formation of carotid artery plaque,to seek the theoretical basis for the prevention and treatment of cerebral infarction and the formation of carotid artery plaque.Method A total of 120 inpatients with acute cerebral infarction admitted to Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine from December 2014 to December 2018 were selected as the cerebral infarction group,and 70 healthy patients in the outpatient physical examination were selected as the control group.The cerebral infarction group was divided into cerebral infarction plaque group(divided into stable plaque group and vulnerable plaque group)and cerebral infarction without plaque group according to the results of carotid artery color Doppler ultrasound examination.The gender and age of all subjects were recorded,blood pressure was detected,and morning fasting venous blood was drew to determine the levels of Hcy,fasting plasma glucose(FPG),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),and uric acid(SUA).The differences in the above indicators between the cerebral infarction group and the control group,the cerebral infarction plaque group and the cerebral infarction without plaque group were compared,and the serum Hcy levels of the stable plaque group and the vulnerable plaque group were compared.The relationship of each index with cerebral infarction and carotid plaque formation was analyzed by Logistic regression analysis.Results Compared with the control group,the levels of SBP and Hcy,FPG,TG,TC,LDL-C,and SUA in the cerebral infarction group were significantly increased(all P<0.05),and the level of HDL-C was significantly reduced(P<0.05),there was no statistically significant difference in the levels of ApoA1 and ApoB and ApoB between the two groups(both P>0.05).Compared with the cerebral infarction without plaque group,the levels of SBP and Hcy,FPG,TG,TC and LDL-C in the cerebral infarction plaque group were significantly increased(all P<0.05),and the level of HDL-C was significantly decreased(P<0.05),there was no significant difference in the levels of ApoA1,ApoB,and SUA between the two groups(all P>0.05).The serum Hcy level of vulnerable plaque group was significantly higher than that of stable plaque group(P<0.05).Serum Hcy level was an influencing factor of cerebral infarction(OR=1.17,P<0.05),and also an influencing factor of carotid plaque formation in patients with cerebral infarction(OR=4.67,P<0.05).Conclusion Hyperhomocysteinemia is an independent risk factor for cerebral infarction and carotid plaque formation;increased levels of Hcy can indirectly reflect the nature of carotid plaques,the higher the level,the worse the stability of carotid plaques.