血浆同型半胱氨酸水平与脑大动脉粥样硬化性病变的相关性分析  

Correlation between plasma level of homocysteine and cerebral large-artery atherosclerosis

作　　者：王桂红[1] 王拥军[1] 何耀[2] 姜卫剑[3] 杜彬[3] 金旻[3] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,100050 [2]解放军总医院老年医学研究所 [3]首都医科大学附属北京天坛医院急诊介入科,100050

出　　处：《中华内科杂志》2006年第9期744-747,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨血浆总同型半胱氨酸(Hcy)水平与脑大动脉粥样硬化性病变的相关性。方法对行数字减影血管造影(DSA)的276例缺血性脑卒中患者进行分组,具有颅内外大动脉粥样硬化性狭窄(至少1支血管狭窄率>50%)的224例患者为狭窄组,无狭窄或轻度狭窄(狭窄率≤50%)患者52例为对照组。对两组患者血浆总 Hcy 水平及脑卒中的常规危险因素如年龄、性别、高血压、糖尿病、长期吸烟、长期饮酒、血甘油三酯、高密度脂蛋白(HDL)、低密度脂蛋白水平等进行了分析。结果脑大动脉粥样硬化性狭窄组血浆 Hcy 升高的比例明显大于对照组(分别为38.8%及15.4%;OR 3.49,95%CI 1.57～7.77,P=0.001)。多元逐步 logistic 回归分析发现,血浆 Hcy 水平升高是脑大动脉粥样硬化性狭窄独立的危险因子(OR=4.10,95% CI:1.80～9.32,P=0.001)。血浆Hcy 升高与高血压、高龄及 HDL 降低合并存在时,其发生脑大动脉粥样硬化性狭窄的风险性增加(OR 值分别4.89、4.79和10.46)。结论来自 DSA 的结果提示,血浆 Hcy 水平升高是脑大动脉粥样硬化性病变独立且强烈的危险因子;与其他危险因子并存,发生脑大动脉粥样硬化性病变的风险性增加。Objective To identify whether high level of plasma homoeysteine is an independent risk factor for potential cerebral large-artery atheroselerotie stenosis determined by digital subtraction angiography （DSA） in patients with isehemie stroke. Methods 276 adult patients with isehemie stroke experienced DSA were selected, and 224 patients with potential large-artery atheroselerotie stenosis（ grade 〉 50%, not less than one of vascular） and 52 controls without stenosis or mild grade （ grade ≤50% ） were included. Plasma homoeysteine level was analyzed and conventional risk factors of cerebral stroke such as sex and age, hypertension, diabetes, long-smoking, long-alcohol and plasma levels of triglyeeride, high-density lipoprotein, low-density lipoprotein was evaluated in 276 subjects. Results The proportion of subjects with high level of plasma homoeysteine （ 〉 15 μmol/L ） was significantly higher in patients with potential atheroselerotie stenosis than those without （ 38.8% versus 15.4% ; OR 3.49,95% CI 1.57-7.77, P = 0. 001 ）. Based on muhivariable stepwise logistic regression model, the odds ratio of homoeysteine levels was 4. 10（95% CI 1.80 -9.32,P =0. 001 ） with additional adjustment for conventional risk factors. The effect of homoeysteine was more pronounced in the presence of hypertension （OR = 4. 89 ）,old age（ OR = 4. 79） and low level of plasma high density lipoprotein （ OR = 10.46）. Conclusions It is suggested that high level of plasma homoeysteine is an independent risk factor for cerebral large-artery atheroselerosis. The effect of homocysteine is more pronounced in the presence of other risk factors of isehemic stroke.

关 键 词：高半胱氨酸 颅内动脉硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]