血浆同型半胱氨酸与脑梗死TOAST亚型相关性研究

目的:探讨血浆同型半胱氨酸(Hcy)浓度与脑梗死TOAST亚型间的相关性。方法:362例脑梗死患者依据TOAST分型诊断标准确定亚型,酶法测定晨起空腹血浆Hcy浓度,秩和检验Hcy水平与TOAST亚型间相关性;彩色多普勒超声检查根据颈动脉内-中膜厚度、血管内膜形态、血流频谱将粥样硬化斑块分为易损和非易损斑块组,对比分析Hcy水平与斑块性质间关系。结果:①大动脉粥样硬化(LAA)型脑梗死患者血浆Hcy水平、高同型半胱氨酸血症(HHcy)发生率显著高于TOAST其他亚型;将心源性栓塞型、小动脉闭塞型、其他原因型、病因不明型4亚型合并为非LAA组后,LAA型Hcy水平和HHcy发生率仍然最高(P<0.05)。②Logistic回归分析显示HHcy是LAA型脑梗死的独立危险因素(OR=7.73,95% CI:2.99~20.01)。③LAA型脑梗死易损斑块组患者血浆Hcy浓度和HHcy发生率均显著高于非易损斑块组(P<0.05);多因素分析显示HHcy和糖尿病是易损斑块的独立危险因素。结论:血浆Hcy增高与TOAST分型中LAA亚型、颈动脉粥样硬化易损斑块密切相关,提示HHcy可能通过引发大动脉粥样硬化而导致脑梗死。

The Clinical Research on Plasma Homocysteine Associating with TOAST Stroke Subtypes

Aim： To investigate the association between plasma homocysteine （Hcy） concentration and stroke subtypes of Acute Stroke Treatment（TOAST） among cerebral infarction patients. Methods： 362 hospitalized stroke patients were classified with Trial of Org 10172 in TOAST criteria. Fasting plasma Hcy level in the morning was tested by enzyme method, and then the correlation between Hcy concentration and TOAST subtype has been researched by rank sum test. Based on intima-media thickness, vessel intima morphology and flow duplex of internal carotid artery checked by Doppler ultrasonic imaging, the carotid atherosclerotic plaque has been discriminated to vulnerable and un-vulnerable group in order to further analyze the association between Hcy level and atherosclerotic plaque feature. Results： （1） Stroke patients with large-artery atherosclerosis （LAA） subtype of TOAST indicated a significantly higher plasma Hcy concentration and hyperhomocysteinemia （HHcy） prevalence than other four stroke subtypes, even after combined cardioembolism （CE）, small-vessel occlusion（SVO）, stroke of other determined etiology （SDE） and stroke of undetermined etiology （SUE） subtypes together （P〈0.05）. （2） HHcy was an independent risk factor of LAA stroke subtype demonstrated by Logistic regression analysis （OR=7.73, 95%CI：2.99-20.01, P〈0.05）. （3） Among stroke patients of LAA subtype presenting with vulnerable carotid atherosclerotic plaque showed remarkable higher Hcy level and HHcy incidence than the group with un-vulnerable plaque, P〈0.05. Multivariate unconditional regression analysis showed HHcy and diabetes mellitus were the independent risk factors for vulnerable carotid plaque. Conclusion： The elevated plasma Hcy level was closely associated with LAA stroke subtype of TOAST and carotid vulnerable plaque. It suggested HHcy induce ischemic stroke mainly via enhancing atherogenic process on large-artery.