颈动脉硬化症与高同型半胱氨酸血症关系的研究  

The relationship between carotid artery atherosclerosis and hyperhomocysteinaemia

作　　者：王宏利[1] 樊东升[1] 沈扬[1] 孙阿萍[1] 张捷[2] 杨玉杰[3] 

机构地区：[1]北京大学第三医院神经科,100083 [2]北京大学第三医院检验科,100083 [3]北京大学第三医院超声诊断科,100083

出　　处：《中华内科杂志》2005年第4期258-261,共4页Chinese Journal of Internal Medicine

基　　金：国家973计划资助项目(G20000569)

摘　　要：目的比较颈动脉硬化症(CAA)程度与血清同型半胱氨酸(Hcy)的水平,探讨其与脑卒中发生的关系和意义。方法以彩色多普勒显像仪检查126例脑卒中患者双侧颈总动脉及颈内动脉颅外段血管,根据血管内径狭窄程度依次分为正常、A、B、C、D共5组;取全部受检者空腹静脉血测定血清Hcy水平,叶酸、维生素(Vit)B12及血脂水平。结果随着CAA所致狭窄程度的逐渐加重,血清Hcy水平逐渐升高,5组受检者的血清Hcy水平依次为(13.22±6.15、16.29±9.81、19.49±11.16、27.21±17.47、24.14±8.64)μmol/L,与正常组相比差异有统计学意义(P<0.01)。而叶酸和VitB12水平逐渐降低,Spearman相关系数分别为-0.23和-0.42,呈显著负相关(P=0.000)。结论Hcy水平升高是CAA的独立危险因素,与CAA程度显著相关;叶酸、VitB12水平低下可能是导致Hcy水平升高的主要原因,临床补充叶酸、VitB12对预防脑卒中的发生具有重要意义。Objective To explore the relationship between the carotid artery atherosclerosis (CAA) and the level of homocysteine (Hcy) as well as folate, vitamin B 12 and lipids.Methods The diameter of common carotid arteries and internal carotid arteries on both sides were meaured by B-mode ultrasound in 126 subjects who were devided into normal and A, B, C, D groups according to the severity of stenosis of CAA. With fasting serum, Hcy as well as folate, vitamin B 12, triglyceriades, total cholesterols(TC), low density lipid (LDL),high density lipid (HDL) were detected.Results When stenosis of CAA became severer, serum Hcy was higher. The levels of the normal and A, B, C, D groups were (13.22±6.15, 16.29±9.81, 19.49±11.16 , 27.21±17.47, 24.14±8.64) μmol/L, respectively. Rank test showed a significant difference between the normal and other groups (P<0.01). Folic acid and VitB 12 were negatively correlated with the Hcy concentrations. Spearman correlation coefficient were -0.23 and -0.42 (P=0.000). According to the severity of stenosis of CAA ,Hcy,age,weight,blood pressure, level of glucose, triglyceriade,TC,LDL,high density lipid (HDL) and history of hypertension, diabates,heart disease and stroke were brought into logistic analysis; the result showed that Hcy,TC, HDL had significant negative correlation with the severity of CAA , Spearman correlation coefficient were 0.56,0.25 and 0.22(P=0.003、0.02、0.04).Conclusion Hyperhomocysteinaemia is an independent risk factor of CAA and the severity of stenosis of CAA is highly correlated with Hcy concentration. The causes of hyperhomocysteinemia may be the results of decrease of folate and VitB 12 levels. Clinical trials are now required to evaluate the effect of treatment with these vitamins in the primary and secondary prevention of vascular diseases.

关 键 词：颈动脉硬化症 高同型半胱氨酸血症 VITB12 血清同型半胱氨酸 彩色多普勒显像仪 颈内动脉颅外段 独立危险因素 狭窄程度 脑卒中患者 Hcy 空腹静脉血 mol/L CAA 颈总动脉 血管内径 血脂水平 相关系数 重要意义 受检者 叶酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]