同型半胱氨酸水平在急性脑梗死再发中的作用

目的 探讨血清同型半胱氨酸（homocysteine,Hcy）水平对脑梗死再发的影响.方法 选择急性脑梗死患者105例,健康对照组90例,比较两者的血清Hcy、叶酸及维生素B12水平;脑梗死组再随机分为A组和B组,A组给予抗血小板、他汀类及活血化瘀等药物,同时口服叶酸和甲钴胺;B组仅给予抗血小板、他汀类及活血化瘀等药物,随访12 m复查血清Hcy水平;观察治疗1年内脑梗死的再发情况.结果 （1）治疗前脑梗死组的Hcy水平显著高于健康对照组,其叶酸和维生素B12水平显著低于对照组（P＜0.001）;且脑梗死组的Hcy水平与叶酸、维生素B12水平呈负相关（P＜0.001）.（2）治疗前A、B两组Hcy水平无显著差异（P＞0.05）,治疗后两者Hcy水平有显著差异（P＜0.001）;A组治疗后Hcy水平显著低于治疗前（P＜0.001）;B组治疗前后Hcy水平无显著差异（P＞0.05）;（3）A组1年内脑梗死再发率为15.01％,B组为21.15％,两组比较差异无统计学意义（P＞0.05）.结论 高同型半胱氨酸血症是脑梗死的危险因素,给予叶酸和维生素B12治疗可有效降低脑梗死患者Hcy水平,但对脑梗死再发影响不大.

The effects of homocysteine level in recurrent ischemic stroke

Object To evaluate the serum homocysteine level in acute ischemic stroke, and its role in preventing re current stroke. Methods In this study, serum levels of homocysteine, folate and B12 vitamin in 105 patients with acute ischemic stroke and 90 healthy controls were measured and compared. Patients with acute ischemic stroke were randomly assigned to receive the conventional treatment, containing asprin, statins, folate, and mecobalamine （A group, n =53）, or only the conventional treatment （B group, n = 52）. Before and after 12-month period follow-up, the serum levels of homocysteine were measured and compared between the two groups （A and B）. Moreover, we observed the recurrence within 1 year of treatment in group A and B. Results （1） Acute ischemic stroke patients had a significantly higher level of homocysteine, but a markedly lower level of folate and B12 vitamin, compared with healthy group （P〈0.001）. Further more, there was a negative linear correlation between levels of folate, BI.2 vitamin and homocysteine in patients with acute ischemic stroke （P〈0.001）. （2） The level of homocysteine showed no significant difference between group A and B before treatment （P〉0.05）, while it showed a statistical difference after treatment （P〈0.001）. In group A, a lower homocysteine level was observed after treatment. （P〈0.001）. However, the same situation has not been found in group B （P〉0.05）. （3） After 12-month period follow-up, the rate of recurrence in group A was lower than that of group B, but there was no markedly difference in statistics （P 〉 0.05 ）. Conclutlons Hyperhomocysteinemia is a risk factor to ischemic stroke. Folate and B 12 vitamin intake can decrease the serum homocysteine levels effectively. But it has little effect on the recurrent cerebral infarction.