血浆同型半胱氨酸水平与脑梗死复发的相关性及临床意义

Correlation and clinical significance of plasma homocysteine level and recurrence of cerebral infarction

目的探究血浆同型半胱氨酸(Hcy)水平与脑梗死复发的相关性及临床意义。方法选取2017年6月至2019年9月本院收治的80例脑梗死患者作为实验组,按Hcy水平及急性卒中治疗低分子肝素试验(TOAST)分型分为脑梗死Hcy升高组(Hcy>15 mmol/L)及脑梗死Hcy正常组(5~15 mmol/L),每组40例;另选取本院同期行健康体检的40名志愿者作为对照组。比较3组血浆Hcy及血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]水平、颈动脉内中膜厚度(IMT);比较脑梗死Hcy升高组及脑梗死Hcy正常组TOAST分型及美国国立卫生研究院卒中量表(NIHSS)评分;分析血浆Hcy、血脂、IMT相关性,评估12个月后脑梗死复发风险。结果脑梗死Hcy升高组TC、TG、LDL、Hcy水平均高于脑梗死Hcy正常组及对照组,IMT大于脑梗死Hcy正常组及对照组,差异有统计学意义(P<0.05)。大动脉粥样硬化性卒中NIHSS评分高于其他亚型,差异有统计学意义(P<0.05)。脑梗死Hcy升高组与脑梗死Hcy正常组脑梗死复发率比较差异无统计学意义。血浆Hcy水平与TC、TG、LDL-C呈正相关(P<0.05);血浆Hcy水平与脑梗死发生率呈正相关(P<0.05)。结论血浆Hcy与脑梗死复发密切相关,其水平升高可引发内皮细胞受损、血管平滑肌细胞增殖、脂质过氧化及血液凝固性增高,诱发脑血管疾病,并可加重脑血管疾病的发展。

Objective To explore the correlation and clinical significance of plasma homocysteine(Hcy)levels and recurrence of cerebral infarction.Methods 80 patients with cerebral infarction who were treated from June 2017 to September 2019 in our hospital were selected as the experimental group,and divided into cerebral infarction Hcy elevated group(Hcy>15 mol/L)and cerebral infarction Hcy normal group(5-15 mol/L),with 40 cases in each group;another 40 volunteers who underwent physical examination in our hospital during the same period were selected as the control group.The plasma Hcy and blood lipid(total cholesterol[TC],triacylglycerol[TG],low-density lipoprotein cholesterol[LDL])levels,and intima-media thickness(IMT)were compared among the three groups.The TOAST classification and neurological deficit(NIHSS)score in the normal group were analyzed;the correlation of plasma Hcy,blood lipids,and medial thickness was analyzed,and the risk of cerebral infarction recurrence after 12 months was evaluated.Results The levels of TC,TG,LDL-C and Hcy in the elevated Hcy group in cerebral infarction were higher than those in the normal Hcy group and the control group,and the thickness of the media was greater than that in the normal Hcy group and the control group,and the difference was statistically significant(P<0.05).The NIHSS score of large atherosclerotic stroke was higher than that of other subtypes,and the difference was statistically significant(P<0.05).There was no significant difference in the recurrence rate of cerebral infarction between the elevated Hcy group and the normal Hcy group in cerebral infarction.Plasma Hcy level was positively correlated with the TC,TG and LDL-C(P<0.05);the plasma Hcy was positively correlated with cerebral infarction(P<0.05).Conclusion The plasma Hcy is closely related to the recurrence of cerebral infarction,the increase of its level can cause endothelial cell damage,vascular smooth muscle cell proliferation,lipid peroxidation and blood coagulation increase,which can induce the occurrence of cerebrovascular disease and aggravate cerebrovascular disease.