缺血性脑卒中复发患者血浆同型半胱氨酸水平变化的临床意义

目的观察脑梗死初发、复发患者血浆同型半胱氨酸（Hcy）水平，探讨脑梗死复发与血浆Hcy的关系。方法用荧光偏振免疫法（FPIA）测定400例急性脑梗死患者及200例非急性脑卒中的对照组患者的血浆Hcy水平；将研究对象（400例）分为不同临床亚组各类型急性脑梗死组（动脉粥样硬化性脑血栓形成组、腔隙性脑梗死组、心源性脑栓塞组），初发组与复发组；比较各组患者血浆Hcy水平及高Hcy水平比率，对脑梗死复发进行多因素分析。结果（1）各类型急性脑梗死患者血浆Hcy水平均高于对照组患者（P〈0．01）；各类型脑梗死患者之间血浆Hcy水平无显著差异；（2）脑梗死复发患者血浆Hcy水平高于初发患者，且高Hcy水平比率（49／97）亦高于初发患者（98／31）3）（P〈0.01）；（3）1年内和1年后复发患者血浆Hcy水平无显著差异；（4）各类型脑梗死复发患者之间血浆Hcy水平无显著差异；（5）多因素分析显示脑梗死复发与高Hcy水平、糖尿病有关（P〈0.01）1、P〈0．05）。结论脑梗死复发与高血浆Hcy水平有一定关系，高血浆Hcy水平可能是脑梗死复发的独立性危险因素。

The value of plasma homocysteinemia concentration in recurrent ischemic stroke

Objective To study the relationship between hyperhomocysteinemia（HHcy） and recurrent cerebral infarction（RCI）. Methods Using fluorescence polarization immunoassay（FPIA） technology we deter- mined the plasma Hcy concentration in 400 patients with acute cerebral infarction（ACI） and 200 non acute stroke people. The 400 patients were divided into subgroup i. e-the subtype of cerebral infarction（atherthromboric brain infarction, lacunar infarct, cerebral embolism） group; the first cerebral infarction（FCI） group and the recurrent cerebral infarction（RCI） group. The plasma Hcy concentration and the incidence of Hhcy were compared in these groups. Multifactoria alanalysis to the risk of RCI was also carried out. Results （1）The concentrations of plasma Hcy in every subtype of cerebral infarction were significantly higher than that in control group （P〈0.01）, and no significant difference was between them （P〉0. 05）. （2） The concentration of plasma Hcy in RCI group was significantly higher than that in FCI group. The incidence of HHcy in the RCI group（49/97） was significantly higher than that in the FCI group（98/303）. （3） The plasma Hcy level in pa- tients with recurrence within one year was not higher than that in patients with recurrence beyond one year. （4） The concentration of plasma Hcy in between these subtypes of RCI was no significant difference （P〉0. 05）. （5） Multifactoria alanalysis indicated RCI was related with HHcy and diabetes mellitus. Conclusions HHcy may be an independently risk factor which is associated with RCI.