急性缺血性脑卒中血浆同型半胱氨酸水平与早期神经功能恶化的相关性研究

摘要

目的 探讨血浆同型半胱氨酸(Hcy)水平和急性缺血性脑卒中(AIS)患者早期神经功能恶化(END)发生的关系.方法 回顾性分析了经头颅MRI确诊的228例AIS患者临床资料.入院7 d内依据美国国立卫生研究院卒中量表(NIHSS)对AIS患者神经功能缺损情况进行多次评估,任意1次NIHSS总分增加≥2分或运动功能评分增加≥1分定义为END,并将全部AIS患者分成非END组和END组.通过比较两组间各变量差异和构建Logistics回归模型,研究血浆Hcy水平和END的相关性.结果 TOAST脑卒中分型在血浆Hcy水平正常组和高Hcy血症组之间分布差异显著,差异有统计学意义(P<0.05).与血浆Hcy水平正常组相比,高Hcy血症组大动脉粥样硬化型脑卒中患者比例相对增多,而小动脉闭塞型脑卒中患者比例相对减少.与非END组相比,END组血浆Hcy水平显著升高;NIHSS评分显著升高,差异有统计学意义(P<0.05).Logistic回归结果显示高水平的血浆Hcy是AIS患者发生END的独立危险因素.结论 血浆Hcy水平升高是AIS发生END的独立危险因素,具有一定的预测价值.%Objective To investigate the association between plasm homocysteine level and early neurological deterioration(END)in patients with acute ischemic stroke(AIS).Methods Two hundred and twenty-eight patients with AIS diagnosed by MRI were recruited.The symptoms of neurological deficits were assessed repeatedly based on the National Institute of Health stroke scale(NIHSS)within 7 days after admission.END was defined as an increase of ≥2 points in NIHSS or an increase of≥1 points in motor function within 7 days after admission.All of the objects were categorized into the END group or non-END group.Univariate analysis and multivariable Logistic regression analysis were performed to explore the association between plasm Hcy level and END.Results According to TOAST classifica-tion,there was significant difference during stroke subtype distribution between the normal plasm Hcy level group and the hyperhomocysteinemia group(P<0.05).In comparison with the normal plasm Hcy level group,the of patients propor-tion with large artery atherosclerosis was more common in the hyperhomocysteinemia group.On the contrary,the number of patients with small vessel disease was lesser in the hyperhomocysteinemia group.Compared with the non-END group, there were significant differences in plasm Hcy level and NIHSS value in the END group(P<0.05).The results of lo-gistic regression analysis revealed that hyperhomocysteinemia was an independent risk factor for END in patients with AIS.Conclusions Increased plasm Hcy level is significantly associated with the development of END in patients with AIS.It has certain predictive and therapeutic value for END.