急性脑梗死患者CISS分型与血同型半胱氨酸、超敏C反应蛋白的相关性研究

摘要

目的：探讨符合中国缺血性卒中亚型(CISS)分型的急性脑梗死(ACI)患者血浆同型半胱氨酸(Hcy)、血清超敏C反应蛋白(hs-CRP)水平及其临床意义。方法选择2013-2014年在我院神经内科住院的ACI患者152例(ACI组)，同期40例健康体检者为对照组，比较两组受检者的血浆同型半胱氨酸(Hcy)及血清hs-CRP水平。ACI患者按CISS分型分为大动脉粥样硬化(LAA)96例，心源性(CS)17例，穿支动脉疾病(PAD)24例，其他病因(OE)4例，不确定病因(UE)11例。其中LAA患者进一步分为载体动脉堵塞穿支动脉30例，动脉到动脉栓塞38例，低灌注/栓子清除下降17例及混合机制组11例，比较各组间Hcy及血清hs-CRP水平。结果 ACI组患者的Hcy、hs-CRP水平显著高于对照组，差异有显著统计学意义(P<0.01)；不同CISS病因分型中，LAA组、CS组患者的Hcy水平高于PAD组、OE组及UE组，差异均有统计学意义(P<0.05)；OE组、LAA组患者的hs-CRP水平明显高于UE、CS组和PAD组，差异有显著统计学意义(P<0.01)；LAA组患者的不同发病机制的Hcy水平，组间比较差异无统计学意义(P>0.05)；载体动脉堵塞穿支组患者的hs-CRP水平显著高于其他各亚组，差异均有显著统计学意义(P<0.01)，动脉到动脉栓塞组患者的hs-CRP水平显著高于低灌注/栓子清除下降组，差异有显著统计学意义(P<0.01)，动脉到动脉栓塞组患者的hs-CRP水平高于混合机制组，差异有统计学意义(P<0.05)。结论检测血浆Hcy、血清hs-CRP水平有助于明确ACI病因及发病机制。%Objective To investigate the levels of plasma homocysteine (Hcy) and serum high-sensitivity C re-active protein (hs-CRP) in patients conform to the standard of Chinese ischemic stroke subtype (CISS) with acute cere-bral infarction (ACI) and its clinical significance. Methods A total of 152 patients with ACI in Department of Neurolo-gy in our hospital were selected as the ACI group, and 40 healthy people for physical examination were enrolled as the control group (with hospitalized time limited from 2013 to 2014). The levels of plasma Hcy and hs-CPR were compared between the two groups. According to the standard of CISS, all the patients were divided into large artery atherosclerosis (LAA group) in 96 cases, cardiogenic (CS group) in 17 cases, perforator artery disease (PAD group) in 24 cases, other causes (OE group) in 4 cases, uncertain etiology (UE group) in 11 cases. Then, the patients with LAA were further subdi-vided as the carrier artery blockage perforator artery in 30 cases, artery to artery embolism in 38 cases, low perfusion/re-move emboli in 17 cases and 11 cases of mixed mechanism. Hcy and serum hs-CRP levels were compared between the groups. Results The levels of hs-CRP and Hcy in ACI patients were significantly higher than those in control group (P<0.01). Hcy levels of LAA, CS group were higher than those in PAD, OE and UE group (P<0.05). The hs-CRP levels of OE, LAA group were significantly higher than those in UE, CS and PAD group (P<0.01). There was no significant differ-ence in the level of Hcy between the LAA subgroups with different pathogenesis (P>0.05). The level of hs-CRP in carri-er perforator artery blockage subgroup was significantly higher than other subgroups (P<0.01). The levels of hs-CRP in artery to artery embolism subgroup were significantly higher than those in hypoperfusion/impaired emboli clearance sub-group (P<0.01). The level of hs-CRP of artery to artery embolization subgroup was significantly higher than that of the mixed mechanism subgroup (P<0.05). Conclusion Detection of plasma Hcy and serum hs-CRP can help clarify the etiol-ogy and pathogenesis of ACI.