高Hcy血症与急性缺血性脑卒中复发相关性研究

目的探讨血浆同型半胱氨酸(Hcy)水平与急性缺血性脑卒中复发的关系。方法将400例急性缺血性脑卒中患者按脑梗死类型分为动脉粥样硬化性血栓性梗死组(血栓组)、腔隙性脑梗死组(腔梗组)及心源性脑栓塞组(栓塞组),同时200例非急性卒中患者作为对照组,用荧光偏振免疫法(FPIA)测定血浆Hcy水平。并在发病后12个月对患者进行随访,确定有无梗死复发。研究患者血浆Hcy水平及1年脑梗死复发率之间的关系。结果 (1)血栓组、腔性脑梗死及栓塞组患者急性期血浆Hcy分别为16.93±11.46μmol.L-1、14.66±7.57μmol.L-1和16.58±8.72μmol.L-1,均高于对照组9.61±4.22μmol.L-1,P值均<0.001。各类型脑梗死患者之间Hcy无显著差异;(2)随访12个月血栓组、腔梗组及栓塞组的复发率分别为8.08%、7.05%和7.55%。各类型脑梗死患者复发率无显著差异;(3)高Hcy血症患者1年复发率11.68%,较非高Hcy血症患者的复发率(5.15%)高(P=0.022);(4)复发患者血浆Hcy水平(18.75±10.27μmol.L-1)高于无复发患者(14.57±8.50μmol.L-1,P=0.014);(5)多因素Logistic分析显示脑梗死复发与高血压(P=0.000)、糖尿病(P=0.000)、高Hcy血症有关(P=0.035)。结果缺血性脑卒中1年复发率与血浆Hcy升高有关,高Hcy血症是缺血性脑卒中复发的独立性危险因素。

Hyperhomocysteinemia and the recurrence of acute ischemic cerebral stroke

Objective To confer the relationship between plasma homocysteine(Hcy)level and acute ischemic cerebral stroke recurrence.Methods Using fluorescence polarization immunoassay(FPIA) to determination of 400 cases of acute ischemic stroke patients and 200 cases of non-acute stroke patients with the control group the level of plasma Hcy.The study(400 cases) according to type of cerebral infarction were divided into three groups: atherosclerotic thrombotic stroke group(thrombosis group),lacunar stroke group(lacunar group),cardiogenic cerebral embolism group(embolization group),measured plasma Hcy levels in each group.Follow-up the patients of 3,6,12 months after onset respectively to determine whether the infarct recurrence.Compareed the recurrence rate and the Hcy level.Result(1)The Hcy level of thrombosis group was 16.93±11.46 μmol/L;the Hcy level of lacunar group was 14.66±7.57μmol/L;the Hcy level of embolization group was 16.58±8.72μmol/L.They were all higer than control group(9.61±4.22μmol/L).There were no significance difference between different types of ischemic cerebral stroke.(2) 12-month recurrence rates of recurrent thrombosis group,lacunar group,embolization group were 8.08%,7.05%,7.55% seperately,showed no significant difference between different types of ischemic cerebral stroke in a year.(3) The recurrence rate of patients with Hyperhomocysteinemia(11.68%) was higher than that without Hyperhomocysteinemia(5.15%)(P=0.022).(4)The plasma Hcy level of recurrence patients(18.75±10.27μmol/L) was higher than that without recurrence(14.57±8.50μmol/L)(P= 0.014).(5) Multifactoria alanalysis indicated the recurrence of ischemic cerebral stroke was related with hypertension(P=0.000),diabetes mellitus(P=0.000),Hhcy(P=0.035).Conclusions The recurrence of ischemic cerebral stroke is related with elevated plasma Hcy.Hyperhomocysteinemia is an independent risk factor of recurrence of ischemic cerebral stroke.