急性脑梗死患者同型半胱氨酸与颈动脉斑块的相关性研究

目的 探讨急性脑梗死患者血清同型半胱氨酸（homocysteine，HCY）与颈动脉斑块的关系。方法 回顾性分析北京朝阳医院西区2013年6月～2014年6月神经内科住院的急性脑梗死患者196例，通过彩色多普勒超声仪测定颈动脉粥样硬化斑块的有无，测定内中膜厚度及其最大斑块厚度。在发病4 d内检测其血清HCY浓度。患者按照有无斑块分为斑块组（n =152）和无斑块组（n =44）。组间比较采用秩和检验，HCY与颈动脉斑块最大厚度的关系采用Spearman秩相关检验。颈动脉斑块形成的危险因素分析采用Logistic回归分析。结果 无斑块组（n =44）的HCY中位数是11.6 μ mol/L，斑块组（n =152）的HCY的中位数是14.0 μ mol/L，秩和检验P =0.011。Spearman相关检验发现HCY与颈动脉最大斑块厚度呈显著正相关，相关系数r =0.247，P <0.001。Logistic回归分析，发现年龄［比值比（odds ratio，OR）1.089，95%可信区间（confidenceinterval，CI）1.050～1.131，P =0.0001］、男性性别（OR 4.304，95%CI 1.738～10.660，P =0.002）、高血压史（OR 3.864，95%CI 1.750～8.534，P =0.001）是影响斑块形成的独立危险因素，而HCY（OR 1.026，95%CI 0.973～1.081，P =0.344）对斑块形成的影响无显著性。但是，对于非心源性脑梗死亚组（n =183）分析发现HCY是斑块形成的独立危险因素（OR 1.267，95%CI 1.006～1.430，P =0.003）。结论 对于急性脑梗死患者，斑块组血清HCY高于无斑块组，血清HCY与颈动脉最大斑块厚度呈正相关。在非心源性脑梗死患者中HCY是颈动脉斑块形成的独立危险因素。

Relationship between Serum Homocysteine and Carotid Atherosclerosis Plaque in Chinese Acute Cerebral Infarction Patients

Objective To explore the relationship between serum homocysteine and carotid atherosclerosis
plaque in Chinese acute cerebral infarction patients.
Methods All 196 hospitalized patients with acute cerebral infarction from June 2013 to June
2014, coming from Chaoyang Hospital west campus, were retrospectively analyzed. All patients
were received carotid ultrasonography screening. To all patients, maximal thickness of carotid
atherosclerosis plaque (MTCAP) and serum homocysteine (HCY) were assessed. Patients were
classified into two groups according to the presence or absence of plaque (152 cases and 44 cases,
respectively).
Results The median of HCY in none plaque group (n=44) and plaque group (n=152) is 11.6 μmol/L and
14.0 μmol/L, respectively, with P value 0.011 (<0.05) in Rank test. Spearman correlation test
showed that there was a liner relationship between HCY and MTCAP, r =0.247, P =0.0001 (<0.05).
Logistic regression revealed that age (odds ratio [OR] value 1.089, 95%confidence interval [CI]
1.050~1.131, P =0.0001), male (OR value 4.304, 95%CI 1.738~10.660, P =0.002), hypertension
history (OR value 3.864, 95%CI 1.750~8.534, P =0.001) were independent risk factors of carotid
atherosclerosis plaque, but HCY (OR value 1.026, 95%CI 0.973~1.081, P =0.344) was not.However, the analysis of none cardiac cerebral infarction subgroup (n =183) according to TOAST
classification method shows that HCY is an independent risk factor of carotid atherosclerosis
plaque (OR value 1.267, 95%CI 1.006~1.430, P =0.003).
Conclusion For Chinese acute infarction patients, serum HCY positively correlates to maximal
thickness of atherosclerosis plaque. And HCY is an independent risk factor to the presence of
carotid atherosclerosis plaque in none cardiac cerebral infarction patients.