血浆高半胱氨酸水平与动脉粥样硬化性类烟雾病的相关性

目的 探讨血浆高半胱氨酸(homocysteine,Hcy)水平与动脉粥样硬化性类烟雾病的关系.方法 选取动脉粥样硬化性类烟雾病缺血性卒中患者(类烟雾病组)95例、大动脉粥样硬化性卒中患者(卒中组)95例、健康志愿者(对照组)94例.检测血浆Hcy水平,收集人口统计学资料、血管危险因素和实验室检查结果 .分析血浆Hcy水平与动脉粥样硬化性类烟雾病的相关性.结果 类烟雾病组高血压、高脂血症、既往卒中或短暂性脑缺血发作(transient ischemic attack,TIA)史、高同种半胱氨酸血症(hyperhomocysteinemia,HHcy)的患者构成比以及收缩压、总胆固醇、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、Hcy、维生素B12、叶酸水平与对照组比较差异有统计学意义(P均<0.017);类烟雾病组既往卒中或TIA史的患者构成比以及收缩压和叶酸水平与卒中组比较差异有统计学意义(P均<0.017).与对照组比较,多变量logistic回归分析显示,HHcy[优势比(odds ratio,OR)1.806,95%可信区间(confidence interval,CI)1.348~2.420;P<0.001]、 既往卒中或TIA史(OR 3.519,95%CI 1.709~7.028;P=0.013)、收缩压(OR 1.099,95%CI 1.035~1.168;P=0.002)、LDL-C(OR 38.473,95%CI 6.384~231.842;P<0.001)是动脉粥样硬化性类烟雾病的独立危险因素,HDL-C(OR 0.025,95%CI 0.001~0.768;P=0.035)和叶酸(OR 0.779,95%CI 0.608~0.996;P=0.047)是其独立保护因素;与卒中组比较,多变量logistic回归分析显示,既往卒中或TIA史(OR 3.280,95%CI 1.664~6.466;P=0.001)、收缩压(OR 1.019,95%CI 1.002~1.035;P=0.029)是类烟雾病的独立危险因素,叶酸(OR 0.845,95%CI 0.750~0.952;P=0.006)是其独立保护因素.结论 血浆Hcy水平升高是动脉粥样硬化性类烟雾病的独立危险因素,在其发病机制中起重要作用.

Correlation between plasma homocysteine level and atherosclerotic quasi-moyamoya disease

Objective To investigate the correlation between plasma homocysteine (Hcy) level and atherosclerotic quasi-moyamoya disease. Methods Ninety-five ischemic stroke patients with atherosclerotic quasi-moyamoya disease (quasi-moyamoya disease group), 95 patients with large atherosclerotic cerebral infarction (stroke group), and 94 healthy volunteers (control group) were selected. The plasma Hcy level was detected, the demographic data, vascular risk factors, and laboratory findings were collected. The correlation between plasma Hcy level and atherosclerotic quasi-moyamoya disease was analyzed. Results There were significant differences in the proportions of patients with hypertension, hyperlipidemia, previous stroke or transient ischemic attack (TIA), hyperhomocysteinemia (HHcy), as well as systolic blood pressure, total cholesterol, low -density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), Hcy, vitamin B12, and folate levels between the quasi-moyamoya disease group and the control group (all P <0.017). There were significant differences in the proportion of patients with previous stroke or TIA, as well as systolic blood pressure, and folate level between the quasi-moyamoya group and the stroke group (all P <0.017). Compared with the control group, multivariate logistic regression analysis showed that HHcy (odds ratio [OR] 1.806, 95% confidence interval [CI] 1.348-2.420; P <0.001), previous stroke or TIA (OR 3.519, 95% CI 1.709-7.028; P =0.013), systolic blood pressure ( OR 1.099, 95% CI 1.035-1.168; P = 0.002), and LDL-C (OR 38.473, 95% CI 6.384-231.842; P < 0.001) were the independent risk factors for atherosclerotic quasi-moyamoya disease, while HDL-C (OR 0.025, 95% CI 0.001-0.768; P = 0.035) and folate (OR 0.779, 95% CI 0.608-0.996; P = 0.047) were its independent protective factors. Compared with the stroke group, multivariate logistic regression analysis showed that previous stroke or TIA(OR 3.280, 95% CI 1.664-6.466; P = 0.001) and systolic blood pressure ( OR 1.019, 95% CI 1.002- 1.035; P =0.029) were the independent risk factors for quasi-moyamoya disease, while folate (OR 0.845, 95% CI 0.750-0.952; P =0.006) was its independent protective factor. Conclusions The elevated plasma Hcy level is an independent risk factor for atherosclerotic quasi-moyamoya disease. It plays an important role in its pathogenesis.