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目的探讨高同型半胱氨酸血症与缺血性脑卒中的关系。方法 136例缺血性脑卒中患者作为研究对象,其中高同型半胱氨酸血症患者95例,作为高同型半胱氨酸血症组;血同型半胱氨酸正常患者41例,作为血同型半胱氨酸正常组。对比两组血管内皮功能[颈动脉内膜中层厚度(IMT)、反应性充血后血管内径变化率(FMD)、一氧化氮(NO)、内皮型NO合成酶(e NOS)]、神经功能缺损程度[美国国立卫生研究院卒中量表(NIHSS)评分]及日常生活能力[Barthel指数(BI)评分],并分析血同型半胱氨酸水平与神经功能缺损程度的相关性。结果高同型半胱氨酸血症组IMT明显高于血同型半胱氨酸正常组,FMD、NO、e NOS均明显低于血同型半胱氨酸正常组,差异均具有统计学意义(U=10.235、9.652、9.124、11.258,P=0.019、0.031、0.035、0.015<0.05)。高同型半胱氨酸血症组NIHSS评分明显高于血同型半胱氨酸正常组,BI评分明显低于血同型半胱氨酸正常组,差异均具有统计学意义(P<0.05)。经Spearman相关分析,血同型半胱氨酸水平与神经功能缺损程度呈正相关(r=0.358,P=0.002<0.05)。结论高同型半胱氨酸血症作为缺血性脑卒中的危险因素,亦可反映患者的病情程度及预后,可能与降低血管内皮功能有关。
Objective To investigate the relationship between hyperhomocysteinemia and ischemic stroke. Methods One hundred and sixty-six patients with ischemic stroke were enrolled in this study. One hundred and fifty-five patients with hyperhomocysteinemia were selected as hyperhomocysteinemia patients and 41 patients with normal blood homocysteine as blood Homocysteine normal group. The vascular endothelial function (carotid intima-media thickness (IMT), rate of change of vascular diameter after reactive hyperemia (FMD), nitric oxide (NO) and endothelial nitric oxide synthase (eNOS) Degree [National Institute of Health Stroke Scale (NIHSS) score] and daily living ability [Barthel index (BI) score], and analyzed the correlation between blood homocysteine level and neurological deficit. Results IMT in hyperhomocysteinemia group was significantly higher than that in normal blood homocysteine group, and FMD, NO and eNOS were significantly lower than those in normal blood homocysteine group (P <0.05), and the difference was statistically significant (U = 10.235,9.652,9.124,11.258, P = 0.019,0.031,0.035,0.015 <0.05). The NIHSS score in hyperhomocysteinemia group was significantly higher than that in normal blood homocysteine group, and the BI score was significantly lower than that in normal blood homocysteine group (P <0.05). Spearman correlation analysis showed that there was a positive correlation between plasma homocysteine level and neurological deficit (r = 0.358, P = 0.002 <0.05). Conclusion Hyperhomocysteinemia as a risk factor for ischemic stroke may also reflect the severity and prognosis of the patients, which may be related to the decrease of vascular endothelial function.