缺血性脑卒中病因学分型与血浆同型半胱氨酸水平的关系分析

摘要

Objective To observe and analyze the relationship between the etiological classification and the plasma homo‐cysteine(Hcy)level in ischemic cerebral stroke(ICS)patients.Methods 180 cases with ICS were selected as the study group and were grouped according to the TOAST etiological classification.The patients with large artery atherosclerosis-type stroke (LAA subtype)were divided into the intracranial lesion group ,the extra-cranial lesion group and the intracranial and extra-cra‐nial lesion group according to the atherosclerotic lesion sites.60 healthy people were selected as the control group.The levels of plasma Hcy ,the triglyceride(TG) ,the total cholesterol(TC) ,the high density lipoprotein(HDL) ,the low density lipoprotein (LDL) ,the blood glucose(BG) ,the systolic blood pressure(SBP) ,the diastolic blood pressure(DBP)of all the included objects were detected and compared.Results The level of plasma Hcy of the study group was significantly higher than that of the con‐trol group(t=4.627 ,P<0.05) ,which was only positively correlated with the age of the included objects(standardized regres‐sion coefficient= 0.386 ,t= 3.862 ,P< 0.05 ).In addition ,the smoking history (OR= 9.134 ) ,the drinking history (OR=1.387) ,the high blood pressure disease(OR=11.687) ,the level of TC(OR=1.517) ,the level of LDL(OR=2.998) ,the level of Hcy(OR=1.156)were positively correlated with the pathogenesis of ICS(P<0.05);The level of plasma Hcy in LAA group was significantly higher than that of other groups(q=3.628~5.126 ,P<0.05) ,which was significantly higher in extracranial lesion group compared with that in the intracranial lesion group or the intracranial and extracranial lesion group(q=5.155 , 4.827 ,P<0.05).Conclusions The increase of the plasma Hcy level is the independent risk factors for ICS ,which especially has a close correlation with the occurrence of LAA subtype and the extracranial arterial lesion ,while has nothing to do with the other traditional factors.The clinicians should take timely and appropriate intervention measures according to the level of plas‐ma Hcy of the patients .%目的：观察和分析缺血性脑卒中（ICS ）病因学分型与血浆同型半胱氨酸（Hcy ）水平的关系。方法选取180例ICS患者为病例组，根据其 TOAST 病因学分型进行分组，并根据动脉粥样硬化病变部位将大动脉粥样硬化型脑卒中（L A A型）患者分为颅内病变组、颅外病变组和颅内外病变组，同时选取60例健康人为对照组。对所有研究对象的血浆 H cy水平、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、血糖（BG）、收缩压（SBP）、舒张压（DBP）等指标进行检测和比较。结果病例组患者的血浆Hcy水平显著高于对照组（t＝4.627，P＜0.05）；血浆Hcy水平仅与受试者的年龄（标化回归系数＝0.386）呈正相关性（t＝3.862，P＜0.05）；吸烟史（OR＝9.134）、饮酒史（OR＝1.387）、高血压（OR＝11.687）、TC水平（OR＝1.517）、LDL水平（OR＝2.998）、Hcy（OR＝1.156）均与ICS发病呈正相关性（P＜0.05）；LAA组患者的血浆 Hcy水平显著高于其他各组研究对象（q＝3.628～5.126，P＜0.05）；颅外病变组患者的血浆 Hcy水平显著高于颅内病变组或颅内外病变组（q＝5.155、4.827，P＜0.05）。结论血浆Hcy水平的升高是ICS发病的独立危险因素，特别是与LAA型ICS及颅外动脉硬化病变的发生具有密切相关性，而其水平与其他传统因素无关，临床医生应根据患者的血浆H cy水平及时采取恰当的干预措施。