高同型半胱氨酸血症致脑梗死病例特点研究

目的探讨高同型半胱氨酸血症脑梗死患者病例特点,为进一步对脑梗死的综合干预提供依据。方法对90例脑梗死患者根据血浆同型半胱氨酸水平分为高同型半胱氨酸血症脑梗死组(Hhcy脑梗死组)60例及同型半胱氨酸正常脑梗死组(nHcy脑梗死组)30例,将其临床特点、血脂水平、血浆纤维蛋白原水平及影像学特点进行回顾性分析。结果 Hhcy脑梗死组患者中男性、吸烟及饮酒者均多于nhcy脑梗死组,血浆Hcy及低密度脂蛋白(LDL-C)水平高于nhcy脑梗死组,并且均有统计学差异(P<0.05)。相关性分析显示Hcy水平与性别相关(r=0.257,P=0.015)。Hhcy脑梗死组病情进展患者比例、复发性脑梗死患者比例、病灶多发者比例均高于nhcy脑梗死组(P<0.05);两组神经功能缺损程度、梗死面积无差别。结论高同型半胱氨酸血症脑梗死发病以男性多见,临床上病情容易进展,脑血管事件再发风险高,影像学上以多发梗死病灶多见。血浆同型半胱氨酸增高对于神经功能缺损程度、脑梗死面积无明显影响。

The study of clinical characteristics of cerebral infarction with hyperhomocysteinemia

Objective To explore the characteristics of cerebral infarction caused by hyperhomocysteinemia.Methods According to the level of homocysteine,we devided 90 cases with cerebral infarction into two groups: cerebral infarction with hyperhomocysteinemia group(HhcyCI group,60 cases) and cerebral infarction with normal homocysteine levels group(nHcyCI,30 cases).The clinical fature,the levels of plasma homocysteine and fibrinogen(FIB),and neuroimaging feature were retrospectively analyzed.Results In the HhcyCI group,male patients were more than the nHcyCI group.And patients who had the history of smoking or drinking were more than the nHcyCI group.The level of homocysteine and LDL-C were higher than the nHcyCI group.The result of the correlation analysis of blood plasma Hcy and other risk factors showed that the plasma Hcy is significantly correlative to gender(r=0.257,P=0.015).Compared with the nHcyCI group,the proportion of patients whose condition were aggravated,proportion of patients suffered recurrent infarction and proportion of patients with multi-infarct lesion in imageology,were higher(P<0.05).There was no significant difference in the severity of neurological deficit and infarct size between the two groups.Conclusions Cerebral infarction caused by hyperhomocysteinemia is common in men and mostly aggravated at the acute phase.Its risk of recurrence is higher,and its neuroimaging feature is characterized by multi-infarct lesion.Elevated plasma homocysteine levels have no effect on the neurological deficit and infarct size.