急性脑梗死患者血浆同型半胱氨酸和氧化低密度脂蛋白的意义

目的观察急性脑梗死患者血浆高敏C-反应蛋白（hsCRP）、同型半胱氨酸（Hey）和氧化低密度脂蛋白（ox—LDL）的水平及其与预后的关系。方法2008年1月至2008年11月收入的90例急性脑梗死患者为观察组，同期健康成人56例为对照组，患者人院后立即采血测定血浆hsCRP，并将上述患者分为hsCRP正常组42例，hsCRP上升组48例。入选患者在服用调血脂药治疗前及治疗后（4周），测定Hey和ox—LDL的水平的变化。其中52例患者治疗后随访6个月，观察再发脑梗死与Hey及ox—LDL的关系。结果患者调脂药治疗后血浆Hey和ox—LDL较治疗前明显下降（P〈0．05），两者均高于正常对照组（P〈0．01）。hsCRP升高组血浆Hey水平与hsCRP正常组比较差异无显著性（P〉0．05）；hsCRP升高组血浆ox-LDL比hsCRP正常组明显升高（P〈0．01）。随访6个月，发生再发脑梗死者8例（15．38％）治疗后血浆Hey和ox—LDL水平均明显高于非发生组（P〈0．05）。结论Hcy、ox—LDL及hsCRP不仅共同参与了动脉粥样硬化的形成，而且可能在导致粥样斑块的不稳定性和促进脑血栓形成过程中起重要的协同作用。

Clinical significance of plasma homocysteine and oxide low density lipoprotein in patients with acute cerebral infarction

Objective To observe the association between the plasma levels of high sensitivity C-reactive protein （hsCRP） , homocysteine （Hey） or oxide low density lipoprotein （ox-LDL） and prognosis in patients with acute cerebral infarction, Methods 90 Patients with acute cerebral infarction were recruited from the Neurology Department from Jan 2008 to Nov 2008. Subjects examined were composed of 90 patients above （cerebral infarction group） and 56 healthy individuals （control group）. Levels of hsCRP were measured when they were hospitalized. Patients were assigned into two groups： the normal hsCRP group （n = 42） and the high hsCRP group（ n = 48）. Before and after the treatment with lipid-lowering drugs （4 weeks） , the plasma levels of Hey and ox-LDL were detected. Among them 52 patients were monitored 6 months after treatment and study the relation between subsequent cerebral infarction and the levels of Hey or ox-LDL. Results The plasma levels of Hey and ox-LDL after the treatment with lipid-lowering drugs （4 weeks） decreased significantly that before the treatment （ P 〈 0. 05 ）. They all higher than the control group （ P 〈 0. 01 ）. There is no significant difference of the level of Hcy between the high hsCRP group and the normal one （ P 〉 0. 05 ）. Compared to the normal hsCRP group, level of ox-LDL of the high hsCRP group were markedly increased （P 〈 0. 01 ）. Over a 6-month period, the levels of Hcy and ox-LDL after the treatment in 8 patients with subsequent cerebral infarction（ 15.38% ） were higher than the patients without it （P 〈 0. 05）. Conclusion Hcy, ox-LDL and hsCRP not only participate in the form of atherosclerosis together, but also may play an important role of conducing the instability of atherosclerotic plaques and promote the cerebral thrombosis.