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目的:探讨血浆同型半胱氨酸(Hcy)浓度与脑梗死TOAST亚型间的相关性。方法:362例脑梗死患者依据TOAST分型诊断标准确定亚型,酶法测定晨起空腹血浆Hcy浓度,秩和检验Hcy水平与TOAST亚型间相关性;彩色多普勒超声检查根据颈动脉内-中膜厚度、血管内膜形态、血流频谱将粥样硬化斑块分为易损和非易损斑块组,对比分析Hcy水平与斑块性质间关系。结果:①大动脉粥样硬化(LAA)型脑梗死患者血浆Hcy水平、高同型半胱氨酸血症(HHcy)发生率显著高于TOAST其他亚型;将心源性栓塞型、小动脉闭塞型、其他原因型、病因不明型4亚型合并为非LAA组后,LAA型Hcy水平和HHcy发生率仍然最高(P<0.05)。②Logistic回归分析显示HHcy是LAA型脑梗死的独立危险因素(OR=7.73,95% CI:2.99~20.01)。③LAA型脑梗死易损斑块组患者血浆Hcy浓度和HHcy发生率均显著高于非易损斑块组(P<0.05);多因素分析显示HHcy和糖尿病是易损斑块的独立危险因素。结论:血浆Hcy增高与TOAST分型中LAA亚型、颈动脉粥样硬化易损斑块密切相关,提示HHcy可能通过引发大动脉粥样硬化而导致脑梗死。
Objective: To investigate the correlation between plasma homocysteine (Hcy) level and TOAST subtype of cerebral infarction. Methods: 362 patients with cerebral infarction were classified according to the TOAST classification diagnostic criteria, the morning fasting plasma Hcy concentration, rank sum test Hcy levels and TOAST subtype correlation; color Doppler ultrasound according to carotid artery Intima-media thickness, intima-media morphology and blood flow spectrum were used to classify atherosclerotic plaques into vulnerable and non-vulnerable plaque groups. The relationship between Hcy level and plaque quality was analyzed. Results: ① The plasma homocysteine level and hyperhomocysteinemia in patients with LAA cerebral infarction were significantly higher than those in other TOAST subtypes. , Other causes, etiology unknown type 4 subtype merged into non-LAA group, LAA type Hcy level and the incidence of HHcy remained the highest (P <0.05). Logistic regression analysis showed that HHcy was an independent risk factor for LAA-type cerebral infarction (OR = 7.73, 95% CI: 2.99-20.01). (3) The plasma homocysteine level and HHcy incidence in patients with vulnerable plaque group were significantly higher than those in non-vulnerable plaque group (P <0.05). Multivariate analysis showed that HHcy and diabetes were independent risk factors for vulnerable plaque. Conclusions: The increase of plasma Hcy is closely related to LAA subtypes and carotid atherosclerosis vulnerable plaques in TOAST classification, suggesting that HHcy may cause cerebral infarction by inducing aortic atherosclerosis.