血浆同型半胱氨酸水平对急性脑梗死预后的影响及干预治疗的作用

目的探讨血浆同型半胱氨酸(Hcy)水平对急性脑梗死(ACI)预后的影响及干预治疗的作用。方法采用荧光法检测152例ACI患者发病<24h(治疗前)、1个月和6个月时血浆Hcy水平。按发病<24h时血浆Hcy水平将患者分为正常Hcy组、高Hcy组,后者又分为干预治疗组给予叶酸5mg/d、维生素(Vit)B620mg/d、VitB120.5mg/d,连续6个月]和常规治疗对照组(常规治疗组)。在发病后各时点对3组患者进行美国国立卫生研究院卒中量表(NIHSS)和Barthel指数(BI)评分。结果治疗6个月时,干预治疗组血浆Hcy水平比治疗前以及常规治疗组明显降低(均P<0.01);正常Hcy组和干预治疗组NIHSS评分明显低于、BI评分明显高于常规治疗组(均P<0.05)。结论血浆Hcy水平增高的ACI患者预后较差,对高Hcy血症干预治疗可以改善ACI的预后。

Influence of plasma homocystine level on the prognosis of acute cerebral infarction and the effect of interventional therapy

Objective To explore the influence of plasma homocystine(Hcy) level on the prognosis of acute cerebral infarction(ACI) and the effect of interventional therapy.Methods The plasma Hcy levels of 152 patients with ACI were measured by fluorometric method at <24 h(pre-treatment),1 month and 6 months after onset.The patients were divided into normal Hcy group and hyperhomocystinemia group according to the level of plasma Hcy at <24 h after onset.The latter was divided into interventional therapy group administering folic acid 5 mg,Vitamine(Vit)B6 20 mg and VitB12 0.5 mg per day,6 months) and conventional therapy control group.At each time point,National Institute Health Stroke Scale(NIHSS) and Bathel Intex(BI) were evaluated.Results 6 months after treatment,the plasma Hcy level of the interventional therapy group was significantly lower than that at <24 h after onset and the conventional therapy group(all P<0.01).The scores of NIHSS were significantly lower and scores of BI were significantly higher in the normal Hcy group and interventional therapy group than those in the conventional therapy group(all P<0.05).Conclusions The prognosis of ACI patients with hyperhomocystinemia is worse.Interventional therapy to hyperhomocystinemia can improve the prognosis of ACI.