同型半胱氨酸与脑小血管病的相关性研究

摘要

目的：探讨血浆同型半胱氨酸（ Hcy）水平与脑小血管病（ SVD）的相关性。方法回顾性分析218例脑SVD患者的临床资料，并根据诊断将其分为无症状脑梗死组（SBI，56例），脑白质疏松组（LA，143例），颅外段动脉硬化组（ EC，28例），颅内段动脉硬化组（ IC，31例）。测定所有患者的血浆Hcy水平，分析其对脑SVD发病的影响。结果脑SVD患者以老年女性居多，高血压、糖尿病比例高，且尿酸、Hcy、CRP 水平也普遍升高。单因素logistic分析显示，血浆Hcy均是SBI、LA、EC、IC发生的危险因素，而多因素logistic回归分析显示，血浆Hcy是SBI（OR：3．47，95％CI：1．76～4．65）、LA（OR：2．98，95％CI：1．48～5．64）的独立危险因素（ P＜0．05），而血浆Hcy与EC、IC无明显相关性（ P＞0．05）。 LA患者中随着Fazekas分级的增加，血浆Hcy水平依次升高（ P＜0．05）。结论血浆Hcy与脑SVD，尤其是SBI、LA具有相关性，是脑SVD发病的独立危险因素，但与脑大血管病变（ EC、IC）之间的关系不明显。%Objective To explore the relationship between plasma homocysteine ( Hcy) and cerebral small vessel disease (SVD).Methods Clinical data on 218 patients with cerebral SVD was retrospectively analyzed , and all the cases were divided into SBI group (n=56), cWMH group(n=143), EC group(n=28), IC group(n=31) according to the diagnosis .Plasma Hcy was determined to analyze its impact on cerebral SVD .Results Cerebral SVD had a higher prevalence of old age , female gender , hypertension , DM, and had higher values for uric acid , Hcy, CRP than those without SVD .Univariate logistic analysis showed that plasma Hcy was risk factors for SBI , LA, EC, IC (P<0.05).Multivariate logistic regression analysis showed that plasma Hcy was independent risk factors for SBI(OR:3.47, 95%CI:1.76~4.65), LA (OR:2.98, 95%CI:1.48~5.64), while plasma Hcy was not found to be associated with EC, IC(P>0.05).With the increase of Fazekas ’ grade, plasma Hcy levels increase in turn among LA patients (P<0.05).Conclusion Plasma Hcy is correlated with cerebral SVD , especially SBI, LA, is an independent risk factors of cerebral SVD , but not found to be obviously associated with cerebral large vessel disease such as EC, IC.