脑卒中类型、病变程度与血清同型半胱氨酸水平的相关性

背景越来越多的研究表明高同型巯乙胺酸(homocysteine,Hcy)是脑血管病的一个独立危险因素,控制Hcy水平对脑血管病发病率、复发率的影响是目前研究的焦点.目的研究不同类型脑卒中血清Hcy水平与常见危险因素的关系.设计病例对照研究.地点和对象2003-01/2003-06北京京煤集团总医院神经内科住院急性脑血管病患者75例,男64例,女11例,年龄33～80岁,均经头颅CT或MRI确诊.选择同期门诊非心脑血管病36例患者为对照组,男29例,女7例,年龄30～70岁.干预采用高压液相层析原理测定血清Hcy水平,用全自动生化仪测血脂、血糖.主要观察指标观察组和对照组血清Hcy水平,血糖、血脂水平,患高血压、脑血管病史者比例.结果血清Hcy水平脑卒中组(18.75±1.8)μmol/L]与对照组(12.84±2.36)μmol/L]比较(t=2.618,P＜0.05);脑梗死组(20.59±1.78)μmol/L]与短暂性脑缺血组(15.6±1.50)μmol/L]比较(t=2.012,P＜0.05);脑梗死组与脑出血组、短暂性脑缺血组与脑出血组间比较(P＞0.05);脑梗死组(20.59±1.78)μmol/L]与对照组(12.84±2.36)μmol/L]比较(t=2.872,P＜0.01);大面积(＞ 2 cm2)梗死组(34.80±2.41)μmol/L]与一般脑梗死组(18.79±1.62)μmol/L]比较(t=2.463,P＜0.05);有高血压组与无高血压组,高血脂组与血脂正常组,既往有脑血管病史者与无脑血管病者;有糖尿病者与无糖尿病者比较,差异均无显著性意义.结论高Hcy是脑血管病独立危险因素,与高血压、高血脂、糖尿病关系不大,在不同类型脑血管病中,与脑梗死关系密切,Hcy增高水平可能与梗死程度有关.

Relativity of the type and grade of stroke with the serum homocysteine level

BACKGROUND: More and more studies prove that homocysteine(Hcy) is one of the possible independent risk factors for cerebrovascular diseases (CVD) . It is a focus of today' s research to observe the effect on the morbidity and recurrence rate of CVD by controlling the Hcy level.OBJECTIVE: To observe the serum Hcy level and the relationship between the serum Hcy level and other familiar risk factors of different typed stroke.DESIGN: Case-control study.SETTING and PARTICIPANTS: Seventy-five inpatients, who were diagnosed as acute CVD by brain CT or MRI in the Neurology Department of General Hospital of Beijing Mining Group from January 2003 to June 2003,were selected. Thirty-six contemporaneous outpatients without cardio-and cerebrovascular diseases, 29 males and 7 females, aged 30 - 70 years, were selected as controls.INTERVENTION: Serum levels of Hcy were assayed with high pressure liquid chromatograph, and levels of blood lipid and sugar were measured with fully automatic biochemical instrument.MAIN OUTCOME MEASURES: Levels of serum Hcy, blood lipid and sugar in the two groups.RESULTS: The levels of serum Hcy were(18. 75 ± 1.8) μmol/L for the stroke group and (12. 84 ±2.36) μmol/L for the control group with significant difference( t = 2. 618, P ＜ 0.05) . The CI group (20. 59 ± 1.78)μ mol/L]and TIA group (15.6 ± 1.50)μmol/L] ( t = 2. 012, P ＜ 0. 05),but not between the CI and cerebral hemorrhage group, between TIA and cerebral hemorrhage groups( P ＞ 0.05) . The CI group and control group ( t = 2. 872, P ＜ 0.01 ), and between the large CI group (34.80 ± 2.41 ]μ mol/L] and the general CI group (18. 79 ± 1.62) μmol/L] ( t =2. 463,P ＜ 0. 05). No significant differences were found between the patients with and without hypertension, between the patients with and without hyperlipemia, between the patients with and without CVD history, and between the patients with and without DM.CONCLUSION: High level of Hcy is one of the independent risk factors for CVD, and has no relation with hypertension, hyperlipemia and diabetes. However, the Hcy level is closely related with CI for the different CVD, and the increase in the level of Hcy may be associated with the degree of CI.