急性后循环多发与单发脑梗死病因分析

目的 分析急性后循环多发与单发脑梗死的病因差异.方法 选择后循环急性脑梗死患者71例,根据磁共振弥散加权成像（DWI）病灶特点分为多发组和单发组,按TOAST分型标准对卒中病因进行分类.结果 28例多发脑梗死中大动脉粥样硬化性卒中19例,心源性栓塞4例,小动脉闭塞性卒中2例,其他原因所致缺血性脑卒中1例,不明原因的缺血性脑卒中2例;43例单发脑梗死中大动脉粥样硬化性卒中10例,心源性栓塞4例,小动脉闭塞性卒中25例,其他原因所致缺血性脑卒中2例,不明原因的缺血性脑卒中2例.多发组与单发组相比,多发组大动脉粥样硬化性卒中更常见（P=0.000）,单发组小动脉闭塞性卒中更常见（P=0.000）.结论 急性后循环多发脑梗死的主要病因是大动脉粥样硬化性卒中,单发脑梗死的主要病因是小动脉闭塞性卒中.     

200例老年女性脑梗死的临床特点

目的分析老年女性脑梗死的临床特点。方法回顾性分析在昆明市延安医院神经内科住院的老年女性首发急性脑梗死患者(年龄≥60岁)200例的临床资料,经影像学及其他病因学检查确诊。依据新版治疗急性卒中试验(NEW.TOAST)分型标准,确定患者病因分型。治疗后3个月,根据改良Rankin评分法(MRS)判断预后。结果收集老年女性脑梗死病因呈多样化,根据TOAST分型构成,大动脉粥样硬化型卒中60例(30.0%),小动脉闭塞型卒中83例(41.5%),心源性脑栓塞型55例(27.5%),其他原因型卒中2例(1.0%),原因不明缺血性卒中0例。危险因素的暴露率最高为血脂异常134例(67.0%),其次为高血压122例(61.0%),心脏病72例(36.0%),糖尿病70例(35.0%),吸烟、饮酒39例(19.5%),高同型半胱氨酸38例(19.0%)。NEW.TOAST分型各组预后较差的是大动脉粥样硬化型,预后较好的是小动脉闭塞型。结论老年女性脑梗死的病因分型以小动脉闭塞型卒中所占比例最高,危险因素中血脂异常和高血压的暴露率高,小动脉闭塞型预后较好。     

前循环急性多发与单发脑梗死病因分析

目的分析前循环急性多发与单发脑梗死病因差异。方法纳入前循环急性脑梗死129例,根据磁共振弥散加权成像（DWI）病灶特点分为多发组和单发组,按TOAST分型标准对卒中病因进行分类。结果 69例多发脑梗死中大动脉粥样硬化性卒中44例,心源性栓塞13例,小动脉闭塞性卒中3例,其他原因所致的脑缺血性卒中4例,不明原因的脑缺血性卒中5例;60例单发脑梗死中大动脉粥样硬化性卒中16例,心源性栓塞5例,小动脉闭塞性卒中34例,其他原因所致的脑缺血性卒中2例,不明原因的脑缺血性卒中3例。多发组与单发组相比,多发组大动脉粥样硬化性卒中更常见（P=0.000）,单发组小动脉闭塞性卒中更常见（P=0.000）。结论前循环急性多发脑梗死的主要病因是大动脉粥样硬化性卒中,急性单发脑梗死的主要病因是小动脉闭塞性卒中。     

不同TOAST亚型脑卒中患者动脉硬化负担分级比较

目的按照TOAST分型标准对急性脑梗死患者进行病因学分型,并评价各类型患者的动脉硬化负担分级。方法选取2014-01—2016-05我院收治的急性脑梗死患者160例,并对其临床资料进行回顾性分析;按照TOAST标准进行病因分型,并根据动脉硬化负担分级对各亚型卒中患者进行分级评价,比较各亚型卒中患者的动脉硬化负担分级。结果 TOAST分型结果:心源性栓塞型(CE)24例(15.38%),大动脉粥样硬化型(LAA)54例(34.62%),小动脉闭塞型(SAO)28例(17.59%),其他明确病因型(ODC)20例(12.82%)及不明原因型(UND)30例(19.23%);动脉硬化负担分级结果:心源性栓塞型患者、大动脉粥样硬化型患者与小动脉闭塞型患者的动脉硬化负担分级程度高于其他明确病因型与不明原因型,差异有统计学意义(P0.05)。结论心源性栓塞型、大动脉粥样硬化型与小动脉闭塞型患者的病因均与血管性因素有关,通过动脉硬化负担分级有利于血管性脑卒中患者的病因诊断。     

青年缺血性脑卒中的TOAST分型及危险因素的临床研究

目的探讨青年缺血性脑卒中的TOAST分型特点及危险因素,为青年缺血性脑卒中的防治提供依据。方法对64例青年缺血性脑卒中患者及对照组150例中老年缺血性脑卒中患者的TOAST分型及危险因素进行回顾性分析。结果青年组TOAST分型为大动脉粥样硬化型43.8%(28/64),小动脉闭塞型15.6%(10/64),心源性脑栓塞型3.1%(2/64),其他原因型25.0%(16/64),原因不明型12.5%(8/64)。中老年组TOAST分型为大动脉粥样硬化型44.0%(66/150)、小动脉闭塞型30.0%(45/150)、心源性脑栓塞型8.0%(12/150)、其他原因型4.0%(6/150)、原因不明型14.0%(21/150)。TOAST分型两组比较差异明显(P<0.05),青年组其他原因型明显高于中老年组(P<0.05),青年组小动脉闭塞型明显低于中老年组(P<0.05)。两组高血压病、高脂血症、吸烟史、酗酒史等危险因素差异不明显(P>0.05);青年组在脑动脉夹层、烟雾病等方面明显高于中老年组(P<0.05);中老年组在糖尿病史、脑卒中史、男性比率方面明显高于青年组(P<0.05)。结论青年缺血性脑卒中TOAST分型及危险因素不同于中老年缺血性脑卒中,既要重视动脉粥样硬化的防治,更要关注相对少见的病因及危险因素。     

血清髓鞘碱性蛋白和超敏C反应蛋白在不同分型脑梗死患者中的变化及意义

目的探讨不同分型脑梗死患者血清髓鞘碱性蛋白和超敏C反应蛋白的变化及意义。方法选取2012-03-2014-04在我院神经内科住院治疗的急性脑梗死患者124例,其中大动脉粥样硬化型脑梗死52例,心源性脑栓塞41例,小动脉闭塞型31例,选取同期在我院体检中心进行健康体检者60例,利用全自动生化分析仪对血清中hs-CRP浓度进行检测,利用酶标仪对血清中MBP浓度进行检测。结果急性脑梗死组患者血清hs-CRP和MBP浓度分别为(2.66±4.21)ng/mL和(4.25±2.12)ng/mL,均高于健康对照组,差异均具有统计学意义(P0.05);不同分型急性脑梗死患者和健康对照血清hsCRP和MBP浓度差异具有统计学意义(P0.05),大动脉粥样硬化型脑梗死患者和心源性脑栓塞患者hs-CRP和MBP浓度均高于小动脉闭塞型和健康对照组,差异均具有统计学意义(P0.05),小动脉闭塞型患者hs-CRP浓度高于健康对照组,差异均具有统计学意义(P0.05)。结论不同类型急性脑梗死患者血清hs-CRP和MBP浓度均出现变化,hs-CRP对早期病变敏感,可早期识别和预测脑梗死,而MBP则可反映脑组织损伤严重程度,对判断患者病情具有重要临床意义。     

动脉粥样硬化性和心源性颅内大血管闭塞对血管内治疗反应性差异研究

目的探讨动脉粥样硬化性和心源性前循环颅内大血管闭塞患者的临床特点以及对血管内治疗反应性的差异。方法回顾性分析行血管内治疗的前循环颅内大血管闭塞的急性缺血性卒中患者的临床资料,比较动脉粥样硬化性和心源性大血管闭塞患者的临床特点、血管内治疗方式、血管开通情况、围手术期并发症及术后神经功能改善状况等。结果共纳入行血管内治疗的前循环大血管闭塞性缺血性卒中患者46例,其中动脉粥样硬化性组24例,心源性栓塞组22例,相比心源性栓塞组,动脉粥样硬化组中吸烟(33%vs 9%,P=0.046)、男性(75%vs 36%,P=0.008)比例显著较高,心房颤动史显著较低(0%vs 82%,P0.001)。动脉粥样硬化组联合使用血管成形术的比例较高(67%vs 27%,P=0.008)。两组患者血管内治疗最终整体再通率、术中并发症、术后神经功能改善方面均未见显著差异。结论动脉粥样硬化与心源性栓塞导致的大血管闭塞性急性前循环缺血性卒中相比,其危险因素和血管内开通措施有所不同,动脉粥样硬化性大血管闭塞患者血管内治疗往往需要联合血管成形术。     

症状性后循环动脉狭窄患者的脑梗死模式研究

目的探寻症状性后循环动脉狭窄患者的脑梗死模式和脑卒中机制。方法发病后48 h内行MR弥散成像(DWI)证实在椎基底动脉(VBA)供血区有急性梗死灶的患者,根据患者病史、临床特征结合头颈部血管成像检查,按相关标准分为动脉粥样硬化组和心源性脑栓塞组,并对两组的脑梗死模式进行比较。结果共收集症状性后循环脑梗死患者115例,其中动脉主干狭窄>50%的脑梗死患者58例(50.4%),心源性脑栓塞患者10例(8.7%)。动脉粥样硬化组最常见狭窄部位是椎动脉V4段(51.7%),其次是基底动脉中段及VBA接合处(41.4%)。多发性梗死在动脉粥样硬化组和心源性脑栓塞组分别为60.3%和70%(P=0.820);双侧梗死在两组分别为43.1%和50%(P=0.951);基底动脉终末支的远端梗死在两组分别为50%和70%(P=0.408)。结论后循环动脉病变以颅内段为主;多发性梗死是后循环动脉狭窄患者脑梗死的重要特征;动脉-动脉性栓塞是多发性脑梗死患者脑卒中的重要病理机制。     

缺血性卒中不同亚型的血浆标志物研究进展

      缺血性卒中按照急性卒中治疗低分子肝素试验病因分型法分型分为大动脉粥样硬化型卒中,小动脉闭塞型卒中,心源性栓塞,其他原因的急性卒中和原因未明的卒中。卒中的发病原因复杂,但在临床实践中发现,即使脑血管显像检查和心脏检查完善,仍有部分患者无法做出准确亚型分类。近年来,卒中相关血浆标志物的检测日益增多,本文主要就缺血性卒中不同亚型的血浆标志物的研究进展做一综述,旨在探讨血浆标志物在卒中不同亚型中的变化及其临床应用价值。     

急性缺血性脑卒中t-PA溶栓治疗不良反应与误用研究进展

急性缺血性卒中(acute ischemic stroke,AIS)的主要类型是心源性脑栓塞和脑动脉血栓形成,血栓形成的病理机制为纤维蛋白形成和血小板活化[1-3]。组织血浆酶原活化剂(tissue plasminogen activator,t-PA)溶栓治疗有助于破坏纤维凝块,使闭塞的血管再通,被认为是AIS最强有力的治疗     

Association of elevated plasma viscosity with small vessel occlusion in ischemic cerebral disease

Introduction

Elevated plasma viscosity (PV) is observed in patients with vascular risk factors, such as diabetes mellitus or arterial hypertension. In this study we investigated the association of plasma viscosity and the different clinical and radiological entities of cerebral ischemia.

Methods

PV of 465 consecutively admitted patients with clinical symptoms of acute cerebral ischemia without radiological signs of bleeding was measured. Data is expressed as median [range] unless stated otherwise. p < 0.05 was considered statistically significant.

Results

Patients with acute cerebral ischemia (TIA or Stroke) showed increased PV (TIA 1.27mPas [1.07-1.53], stroke 1.27mPas [1.07-1.56]) compared to patients without cerebral ischemia (Mimics) (1.23mPas [1.06-1.42]). The group with radiologically proven small vessel disease (SVD) had a significantly higher mean values of PV (1.29mPas [1.06-1.54]) compared to those with signs of large vessel disease or cardioembolic events (1.22mPas [1.07-1.56], p < 0.001).Patients with chronic heart failure (p = 0.007), arterial hypertension (p < 0.001) and diabetes mellitus (p = 0.002) had higher PV compared to patients without these cardiovascular risk factors. Hyperlipidemia or nicotine abuse showed no relation to PV.

Conclusion

Elevated PV is not only associated TIA and Stroke but is also found in patients with radiological signs of cerebral SVD. High levels of PV could be an underestimated risk for TIA and Stroke and participate in the complex pathophysiology of SVD. Prospective observational and interventional studies are warranted for further evaluation of PV in neurological ischemic diseases.     

大动脉粥样硬化型与小动脉闭塞型青年缺血性卒中高危因素相关分析

目的探讨青年缺血性卒中两种不同病因分类亚型的高危因素的差别。方法收集北京大学第一医院神经内科(2006-2011年,18～45岁)缺血性卒中病人。入选66例,分为大动脉粥样硬化组(46例)及小动脉闭塞组(20例)。以性别、年龄、既往病史(包括高血压、糖尿病、长期大量吸烟、饮酒史)以及周围血检测(甘油三脂、低密度脂蛋白、高密度脂蛋白、同型半胱氨酸)研究变量。结果单变量分析发现大动脉粥样硬化组低密度脂蛋白升高率及甘油三酯升高率与小动脉闭塞组比较有显著性差异(P<0.05)。小动脉闭塞组血压升高率与大动脉粥样硬化组比较有显著性差异(P<0.05),其他高危因素比较差异无显著性意义(P>0.05)。logistic回归分析发现甘油三酯升高率(wald=4.372,95%CI 0.089-0.925,p=0.037)与大动脉粥样硬化性青年缺血性卒中有关。高血压(wald=4.764,95%CI 1.196-21.986,p=0.029)与小动脉闭塞性青年缺血性卒中有关。结论两种不同病因的青年缺血性卒中主要致病高危因素不同,大动脉粥样硬化型需要更好的调控血脂,尤其是甘油三酯,而小动脉闭塞型需要更好的控制血压。     

Development of a predictive scale for cardioembolic stroke using extracted thrombi and angiographic findings

We analyzed the histopathological findings of the clots obtained from patients with acute ischemic stroke by mechanical thrombectomy. We then developed a clinical scoring system for predicting pathogenic causes in patients with undetermined ischemic stroke using these histopathological and the angiographic findings during endovascular treatment. Only cases with the occlusion of the intracranial internal carotid artery or the proximal part of the middle cerebral artery were included in this study. Histopathologic findings of clots were compared and analyzed using the Trial of Org 10,172 in Acute Stroke Treatment (TOAST; large artery atherosclerosis, cardioembolic, and undetermined groups) and angiographic occlusion type (AOT; branching-site occlusion and truncal-type occlusion groups) classification systems. Fifty-two patients had enough clots extracted by mechanical thrombectomy for full histopathologic examination. There was no significant within-group difference in the fraction of components in the thrombi for either the TOAST or AOT system; however, the platelet distribution patterns were different. The large artery atherosclerotic group and truncal-type occlusion group had mostly peripheral patterns, whereas the cardioembolic group, undetermined group and branching-site occlusion group had mostly clustering patterns (p = 0.02 in TOAST classification; p = 0.007 in AOT classification). Patients with scores of 3 or 4 on our new scale had a sensitivity of 93.5% and a specificity of 100% for cardioembolic stroke. The BOCS₂ scale, developed using a combination of the TOAST and AOT classification systems, may be helpful as an adjunctive diagnostic tool for identifying cases caused by cardiogenic embolism in patients with undetermined ischemic stroke.     

Lipoprotein(a), other lipoproteins and hemostatic profiles in patients with ischemic stroke: the relation to cardiogenic embolism

Lipoprotein and hemostatic profiles including coagulation inhibitors were determined in 136 patients with acute ischemic stroke. Based on clinical examination, cerebral computed tomography, Doppler ultrasonography of precerebral arteries and transthoracic echocardiography, the strokes were classified as cardioembolic (n = 38), non-cardioembolic (n = 92), and mixed cardioembolic/hypertensive (n = 6). Patients with cardioembolic stroke were older than patients with non-cardioembolic stroke. Lipoprotein(a) was higher in the cardioembolic than in the non-cardioembolic group. Lipoprotein(a) was not significantly correlated to the other lipid levels and may represent an independent lipid risk factor. The non-cardioembolic group had higher levels of total cholesterol, triglycerides, total cholesterol/high-density lipoprotein cholesterol ratio, low-density lipoprotein cholesterol, apolipoprotein A1, and apolipoprotein B. The cardioembolic group had higher concentrations of fibrinogen and D-dimer, and lower levels of antithrombin, protein C, protein S and heparin cofactor 2 than the non-cardioembolic group. The differences in the hemostatic profile are consistent with thrombosis due to activated coagulation being more involved in the pathogenesis of cardioembolic than of non-cardioembolic stroke. Lipoprotein(a) seems to be more associated with coagulation markers of thrombosis than with atherosclerosis, whereas the other lipids mainly seem to be risk factors for atherosclerosis.     

Tissue plasminogen activator and plasminogen activator inhibitor in patients with acute ischemic stroke: relation to stroke etiology

Recent studies suggest that high plasma levels of tissue-type plasminogen activator (tPA) and its inhibitor (plasminogen activator inhibitor-1, PAI-1) are markers of an increased risk of atherothrombotic ischemic events such as stroke and myocardial infarction. In this prospective study, we measured tPA antigen, PAI-1 antigen and activity, as well as tPA/PAI-1 complex in patients with acute stroke. Stroke subtypes were classified according to the TOAST criteria. From 132 consecutively screened patients, 89 (100%) were enrolled in this study, including 42 patients (47%) with large artery atherosclerosis (LAA), 32 (36%) with small vessel occlusion (SVO), and 15 (17%) with cardioembolism (CE). Nineteen age-matched neurologic patients without manifestations of cerebrovascular disease served as control subjects (CS). Patients with acute stroke had significantly higher plasma levels of tPA antigen (p < 0.001), PAI-1 antigen (p < 0.05) and PAI activity (p < 0.05) than patients in the control group. t-PA antigen, PAI activity and tPA/PAI-1 complex levels were similar regardless of stroke etiology. Only PAI-1 antigen was lower in patients with cardioembolic stroke than in stroke patients with LAA (p < 0.05). Plasma tPA antigen, PAI-1 antigen, and PAI activity are significantly increased in patients with acute ischemic stroke. Except for PAI-1 antigen, this increase appears not to be related to the underlying stroke etiology.     

Aortic atherosclerosis and stroke.

Methods: Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk factor for stroke, particularly stroke of undetermined mechanism, but controls in prior studies were not balanced for vascular risk factors. We used TEE to evaluate aortic atherosclerosis in 60 patients with stroke compared with a high-risk control population of 46 subjects. We also examined the possible association of plasma viscosity and fibrinogen levels to aortic atherosclerosis. Results: The mean maximal plaque thickness (MMPT) was similar for the control (2.8 +/- 3.6 mm) and the stroke group (3.3 +/- 3.5 mm), but varied with stroke mechanism. The MMPT was similar in stroke of undetermined and atherosclerotic mechanism [3.5 +/- 4 mm (n = 25) and 4.2 +/- 4.3 mm (n = 16), respectively], significantly greater than in stroke of other mechanisms (1.7 +/- 1.2 mm, P < .05, n = 19). Patients with stroke of undetermined mechanism were four times more likely (95% confidence interval [CI] 1.2-12) to have plaques >/=5 mm compared with controls. Ulcerated plaque was associated with plaque thickness (P < .001) and plasma viscosity (P < .001). Conclusions: Aortic atherosclerosis is associated with stroke of undetermined cause suggesting atherosclerosis is a cause of stroke of undetermined etiology. Plaque ulceration was associated with the thickness of aortic plaque and plasma viscosity.     

脑梗死血浆正五聚蛋白3的动态改变及与颈动脉不稳定斑块的关系

目的研究急性缺血性脑卒中与血浆正五聚蛋白3(pentraxin 3,PTX3)水平的关系,并探索血浆PTX3水平与颈动脉粥样硬化的关系。方法纳入急性缺血性脑卒中患者共103例,对照组患者83例。应用酶联免疫吸附法(ELISA)检测所有患者入院时的血浆PTX3水平,以及急性缺血性脑卒中患者规律治疗第7天的血浆PTX3水平。对急性缺血性脑卒中患者进行颈部多普勒血管超声检查,根据颈动脉斑块稳定性将患者分为两组。研究血浆PTX3水平与急性缺血性脑卒中及颈部斑块稳定性之间的关系。结果 (1)急性缺血性脑卒中组的血浆PTX3水平明显高于对照组(P0.05),经规律治疗7 d后,恢复期的血浆PTX3水平明显低于急性期(P0.05),但仍高于对照组(P0.05)。经多因素Logistic回归后提示血浆PTX3水平与急性缺血性脑卒中密切相关(OR=15.043,95%CI:3.46~65.45,P0.001)。(2)急性缺血性脑卒中组中,不稳定斑块组急性期和恢复期的血浆PTX3水平均高于无斑块与稳定斑块组(P0.05)。结论急性缺血性脑卒中患者具有较高的血浆PTX3水平,伴有颈动脉不稳定斑块的急性缺血性脑卒中患者血浆PTX3水平更高。血浆PTX3水平与急性缺血性脑卒中密切相关。     

急性脑梗死患者血清r-谷氨酰转移酶水平与病因学分型、病情严重程度的关系

目的 探讨脑梗死患者血清r-谷氨酰转移酶(r-GT)水平的变化及其临床意义。方法 收集126例脑梗死患者,采用ELISA法测定r-GT、血糖、血脂水平,进行TOAST病因学分型,对患者入院时行NIHSS评分,<8分定义为轻度脑梗死,≥8分定义为中重度脑梗死,选取130例同期门诊体检健康者作为对照组,收集r-GT水平,比较脑梗死组和对照组r-GT水平的差异及大动脉粥样硬化组和小动脉闭塞组r-GT水平的差异,进一步分析r-GT水平和脑梗死严重程度的相关性。结果 脑梗死组r-GT水平明显高于对照组(P<0.01)。大动脉粥样硬化组r-GT水平高于小动脉闭塞组(P<0.05),而2组间其他动脉粥样硬化相关危险因素无明显差异(P>0.05)。中重度脑梗死组r-GT水平明显高于轻度脑梗死组(P<0.01),多变量logistic回归分析显示,血清r-GT[比值比(OR)1.058,95%可信区间(CI)1.001～1.118,P<0.05]水平升高与脑梗死病情严重程度存在独立相关性。结论 急性脑梗死患者r-GT水平明显升高,作为一种氧化应激指标,可帮助区别大动脉粥样硬化性脑梗死和小动脉闭塞性脑梗死,且r-GT水平与神经功能缺损程度存在显著相关性。     

Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion

Acute ischemic stroke with major intracranial vessel occlusion is commonly due to cardioembolic or atherosclerosis-related in situ stenosis/occlusion, and immediate identification of these subtypes is important to establish the optimal treatment strategy. The aim of this study was to clarify the differences in clinical presentation, radiological findings, neurological temporal courses, and outcomes between these etiologies, which have not been fully evaluated. Consecutive emergency patients with acute ischemic stroke were retrospectively reviewed. Among them, patients with stroke with major intracranial vessel occlusion were analyzed with a focus on clinical and radiological findings, and a comparison was performed for those with cardioembolic or atherosclerosis-related in situ stenosis/occlusion. Of 1053 patients, 80 had stroke with acute major intracranial vessel occlusion (45 with cardioembolic and 35 with atherosclerosis-related in situ stenosis/occlusion). Interestingly, the susceptibility vessel sign (SVS) on T2-weighted MR angiography was more frequently detected in cardioembolic stroke (80.0%) than in atherosclerosis (in situ stenosis: 5.9%, chronic occlusion: 14.3%). Moreover, the proximal intra-arterial signal (IAS) on arterial spin labeling MRI and the distal IAS on fluid attenuated inversion recovery MRI was less frequently detected in chronic occlusion (27.3% and 50.0%, respectively) than in acute occlusion due to cardioembolic or in situ stenosis. Multivariate regression analysis showed that the SVS was significantly related to cardioembolism (adjusted odds ratio (OR): 21.68, P = 0.004). Clinical characteristics of acute stroke with major intracranial vessel occlusion differ depending on the etiology. The SVS and proximal/distal IAS on MRI are useful to distinguish between cardioembolic and atherosclerotic-related in situ stenosis/occlusion.     

正常范围同型半胱氨酸不同水平与复发性脑梗死的相关性研究

目的 探讨正常范围同型半胱氨酸（homocysteine,Hcy）水平与复发性脑梗死之间的关系。