急性脑梗死患者同型半胱氨酸与叶酸、维生素B12和血脂水平的关系  

Relationship between honmcysteine acid, vitamin B12 and lipid in patients and the levels of plasma folic with acute cereirai infarction

作　　者：刘旭[1] 马昱[1] 汪昕[1] 

机构地区：[1]复旦大学附属中山医院神经内科,上海200032

出　　处：《国际脑血管病杂志》2009年第11期836-839,共4页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性脑梗死患者与正常对照者血浆同型半胱氨酸（homocysteine，Hcy）水平的差别，以及急性脑梗死患者血浆Hcy水平与叶酸、维生素B12和血脂水平以及临床症状之间的关系。方法纳入年龄、性别、高血压和糖尿病等配比因素无显著性差异的91例首次发病的急性脑梗死患者和100例无脑血管意外的对照者，采用循环酶法测定血浆Hcy水平，化学发光法测定叶酸、维生素B12水平，生化分析仪速立法测量血脂水平，急性脑梗死患者进行美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评价。结果急性脑梗死组血浆Hcy水平为（21．22±7．29）μmol／L，显著高于对照组的（13．19±2．13）μmol／L（P〈0．05）；急性脑梗死组血浆Hcy水平与叶酸（r=-0．307，P〈0．05）和维生素B12（r=-0．27，P〈0．05）水平均呈显著负相关，与低密度脂蛋白呈显著正相关（r=0．282，P〈0．05），与高密度脂蛋白呈显著负相关（r=-0．219，P〈0．05）；急性脑梗死组血浆Hcy水平均值随NIHSS评分升高而增高（P〈0．05）。结论高Hcy血症是急性脑梗死的独立危险因素，叶酸和维生素B12水平随着Hcy水平的升高而降低；血浆Hcy水平越高，临床症状越严重；Hcy可能通过影响血脂代谢增高缺血性脑血管病的风险。Objective To investigate the differences of the plasma homocysteine （Hcy） between the patients with acute cerebral infarction and the normal controls, and the relationship between the levels of plasma Hcy and folic acid, vitamin B12 and lipids, and the relationship between clinical symptoms in patients with acute cerebral infarction. Methods A total of 91 patients with first-ever acute cerebral infarction and 100 controls without cerebrovascular accident were included. ]heir ratio factors such as age, sex, hypertension and diabetes did not have significant differences. Enzymatic cycling was used to detect plasma Hcy levels. Chemiluminescence was use to detect folic acid and vitamin B12 levels. Biochemical analyzer was used to measure lipid levels. The patients with acute cerebral infarction were evaluated by the National Institutes of Health Stroke Scale （NIHSS）. Results qhe plasma Hcy level was significant higher in the acute cerebral infarction group than that in the control group （21.22 - 7.29μmol/L vs. 13.19 ± 2. 13 p, mol/L） （P 〈 0.05）; the plasma Hcy level in the acute cerebral infarction group was significantly negatively correlated with folic acid （r = - 0.307, P 〈0.05） and vitamin B12 （r = - 0. 270, P 〈 0.05）. It was significantly positively correlated with low-density lipoprotein （r = 0. 282, P 〈 0.05）, and it was significantly negatively correlated with high-density lipoprotein （r = - 0.219, P 〈 0.05）. The mean value of the plasma Hcy in acute cerebral infarction group increased with the increase of NIHSS scores. Conclusions Hyperhomocysteinemia is an independent risk factor for acute cerebral infarction. The levels of folic acid and vitamin B12 decreased with the increase of Hcy levels. The higher the Hcy levels, the more serious the clinical symptoms are. Hcy may increase the risk of ischemic cerebrovascular disease by influencing the lipid metabolism.

关 键 词：脑梗死 高半胱氨酸 叶酸 维生素B12 高脂血症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]