血浆同型半胱氨酸与缺血性脑血管病患者颈动脉粥样硬化斑块的关系

摘要

Objective To investigate the relationship between plasma homocysteine ( Hey ) level and carotid atherosclerotic ( CAS ) plaques in patients with ischemic cerebrovascular disease. Methods A total of 327 patients with first-ever ischemic stroke admitted in the First Affiliated Hospital of Medical College of Xian Jiaotong University from February 2009 to August 2011 were collected, 264 of them were cerebral infarction and 63 were TIA of internal carotid artery system. Color Doppler ultrasound of carotid artery was used to detect the carotid artery intima-media thickness ( IMT ), intimal morphology and flow spectrum. The degree of CAS in patients was assessed comprehensively. The patients were divided into three groups: The normal IMT group, the IMT thickening group and the plaque formation groups. Enzyme-linked immu-nosorbent assay was used to detect the fasting plasma Hey level in the morning. The relationship between the plasma Hey levels and the carotid atherosclerotic plaques were analyzed. Results (T)Of the 327 patients, 99 were normal IMT, 40 were IMT thickening, and 188 were atherosclerotic plaque formation. Of the 188 patients with atherosclerotic plaque formation, 82 were in the vulnerable plaque group and 106 were in the non-vulnerable plaque group. ?The plasma Hey levels ( median ) in the normal IMT, IMT thickeningand plaque formation groups were 13. 6, 22. 3 and 28. 6 |xmmol/L, respectively. The incidences of hyperho-mocysteinemia ( Hhcy ) were 40. 4% ( 40/99 ), 70.0% ( 28/40 ) and 75. 5% ( 142/188 ), respectively. Except there was no significant difference in the incidence of Hhcy between the IMT thickening group and the plaque formation group, there were significant differences in the outcome measures among the 3 groups ( all P<0.05 ). ?The incidences of plasma Hey level and Hhcy in the vulnerable plaque group were 28. 9 |xmol/L and 82. 9% respectively, and they were significantly higher than 23. 4 |xmol/L and 69. 8% in the non-vulnerable plaque group. There were significant differences ( all P <0. 05 ). (4) Multivariate logistic regression analysis showed that the increased Hey level was an independent risk factor for carotid atherosclerotic plaque formation ( 0R = l. 14, 95% CI: 1. 04 - 1. 25 ). Conclusion With the increased plasma Hey levels, the severity of carotid artery atherosclerosis is also increased. Hhcy is an independent risk factor for carotid atherosclerotic plaque formation.%目的 探讨缺血性脑血管病患者血浆同型半胱氨酸(Hcy)水平与颈动脉粥样硬化斑块的关系.方法 选择327例发病时间≤7 d、首次发病的缺血性脑血管病患者,其中脑梗死264例,颈内动脉系统短暂性脑缺血发作(TIA)63例.采用颈动脉彩色多普勒超声检查颈动脉内 - 中膜厚度(IMT),综合评估患者颈动脉粥样硬化程度及斑块性质.并根据超声结果将患者分为IMT正常组、IMT增厚组、斑块形成组;酶联免疫吸附法测定晨起空腹血浆Hcy浓度.分析血浆Hcy水平与颈动脉粥样硬化斑块的关系.结果 ①327例患者中,99例为IMT正常,40例为IMT增厚,188例为粥样斑块形成.在188例斑块形成的患者中,易损斑块组82例,非易损斑块组106例.②IMT正常组、IMT增厚组、斑块形成组的血浆Hcy浓度(中位数)分别为13.6、22.3、28.6 μmol/L,高同型半胱氨酸血症(HHcy )的发生率分别为 40.4%(40/99)、70.0%(28/40)、75.5%(142/188).除IMT增厚组与斑块形成组间HHcy发生率差异无统计学意义外,3组间观察指标比较差异均有统计学意义(均P<0.05).③易损斑块组血浆Hcy浓度和HHcy发生率分别为28.9 μmol/L和82.9%,高于非易损斑块组的23.4 μmol/L和69.8%,差异均有统计学意义,P<0.05.④多因素Logistic回归分析显示,Hcy浓度增高是颈动脉粥样斑块形成的独立危险因素(OR=1.14,95%CI:1.04~1.25) 结论 随着血浆Hcy水平的升高,颈动脉粥样硬化程度随之升高.HHcy是颈动脉粥样硬化斑块形成的独立危险因素.