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目的探讨高同型半胱氨酸血症(hyperhom ocysteinemia,Hhcy)对缺血性卒中(IS)患者再发、死亡及冠状动脉和外周动脉缺血性事件发生的影响,为进一步对缺血性血管病的综合干预提供依据。方法检测245例IS患者空腹血浆同型半胱氨酸(Hcy)水平,并参照同期选取的52例健康体检者为对照者按血浆Hcy水平将其分为Hhcy组和非Hhcy组,追踪观察两组患者IS再发、死亡及冠状动脉和外周动脉缺血事件的发生情况。结果其中Hhcy组IS再发率(52.63%)显著高于非Hhcy组(24.67%)(P<0.01);死亡事件发生率(12.63%)亦显著高于非Hhcy组(3.33%)(P<0.01);冠脉缺血事件发生率(18.95%)明显高于非Hhcy组(10.00%)(P<0.05);外周动脉缺血事件发生率两组分别为5.26%和2.67%,差异无统计学意义(P>0.05);并发2种以上缺血性事件的患者Hhcy组(17.89%)显著多于非Hhcy组(5.33%)(P<0.01);Hhcy组患者5年内缺血性血管事件发生率(57.89%)显著高于非Hhcy组(32.00%)(P<0.01);Logistic回归分析发现,Hcy升高是IS患者缺血性血管事件再发的独立危险因素(OR分别为1.174;95%CI1.119~1.233;P<0.05)。结论 Hhcy与IS患者缺血性血管事件再发及死亡预后密切相关。
Objective To investigate the effect of hyperhomocysteinemia (Hhcy) on the recurrence and death of ischemic stroke (IS) patients and the occurrence of ischemic events in coronary and peripheral arteries. To investigate the effects of hyperhomocysteinemia Comprehensive medical intervention provides the basis. Methods The fasting plasma homocysteine (Hcy) levels were measured in 245 patients with IS and divided into Hhcy group and non-Hhcy group according to the level of plasma Hcy in 52 healthy controls. Patients with recurrent IS, death and coronary artery and peripheral arterial ischemic events. Results The recurrence rate of IS in Hhcy group was significantly higher than that in non-Hhcy group (24.67%, 52.63%, P <0.01). The incidence of death was also significantly higher in Hhcy group than in non-Hhcy group (3.33%, P < 0.01). The incidence of coronary artery ischemia was significantly higher than that of non-Hhcy group (18.95% vs 10.00%, P <0.05). The incidence of peripheral arterial ischemia was 5.26% and 2.67% (P> 0.05). Hhcy group (17.89%) with more than two kinds of ischemic events was significantly more than the non-Hhcy group (5.33%) (P <0.01); Hhcy group within 5 years of ischemic vascular events (57.89%) were significantly higher than those in non-Hhcy group (32.00%) (P <0.01). Logistic regression analysis showed that elevated Hcy was an independent risk factor for recurrent ischemic events in IS patients (OR = 1.174; 95% CI 1.119-1.233; P <0.05). Conclusion Hhcy is closely related to the recurrence of ischemic vascular events and the prognosis of death in IS patients.