高同型半胱氨酸血症与脑动脉斑块性质的相关性研究  

Research of the relationship between hyperhomocysteinemia and the property of cerebral artery plaque

作　　者：刘勇[1] 古美颖[1] 彭小琼[1] 李王文 

机构地区：[1]重庆三峡中心医院神经内科,重庆市404000

出　　处：《中国基层医药》2017年第20期3066-3069,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：重庆市万州区科技计划项目（201503024）

摘　　要：目的 探讨高同型半胱氨酸血症与脑动脉斑块性质的相关性,对高同型半胱氨酸导致急性脑卒中的致病机制予以研究.方法 选择急性缺血性脑卒中患者60例,测定同型半胱氨酸,高同型半胱氨酸组为观察组、正常同型半胱氨酸组为对照组,各30例;采用高分辨率磁共振成像（HRMRI）多对比度斑块成像技术,测定脑动脉斑块负荷、脂核占斑块比率、斑块内出血、维帽破裂情况;使用对比剂的转移常数识别斑块内炎症细胞的数量以及新生血管的密度.结果 观察组低危斑块4例（13.33％）、中危斑块10例（33.33％）、高危斑块16例（53.33％）,对照组低危斑块13例（43.33％）、中危斑块6例（20.00％）、高危斑块11例（36.67％）,观察组脑动脉粥样硬化易损斑块危险分层程度高于对照组（U=-2.032,P=0.042）;观察组斑块无内出血12例（40.00％）、斑块内出血18例（60.00％）,对照组斑块无内出血22例（73.33％）、斑块内出血8例（26.67％）,观察组的斑块内出血风险高于对照组（χ2 =6.79,P=0.009）;观察组纤维帽未破裂9例（30.00％）、纤维帽破裂21例（70.00％）,对照组纤维帽未破裂17例（56.67％）、纤维帽破裂13例（43.33％）,观察组纤维帽破裂风险高于对照组（χ2=4.34,P=0.037）;斑块内炎性细胞的数量以及新生血管的密度观察组为（0.188 ±0.265） Ktrans/min、对照组为（0.118 ±0.183）Ktrans/min,观察组斑块内炎性细胞的数量以及新生血管的密度高于对照组（t=11.831,P=0.000）.结论 高同型半胱氨酸导致斑块内出血、维帽破裂、斑块内炎性细胞活跃及新生血管增加,加速脑动脉粥样硬化、增加缺血性卒中事件的发生.Objective To study the correlation between hyperhomocystinemia and the property of cerebral artery plaque,and the pathogenic mechanism of hyperhomocystinemia resulting in acute cerebral stroke.Methods 60 patients with acute ischemic stroke were chosen.30 patients with normal homocysteine were classified as control group.The other 30 patients with hyperhomocystinemia were classified as observation group.High resolution magnetic resonance imaging（HRMRI） and multi contrast plaque imaging technique were used to measure the cerebral artery plaque burden,the fat ratio of plaques,the hemorrhage within the plaque and fibrouscap rupture.The number of inflammatory cells in the plaque and the density of the new blood vessels were identified using the transfer constant of the contrast medium.Results In the observation group,4 cases with low-risk plaques （13.33%）,10 cases with middle-risk plaques （33.33 %） and 16 cases with high-risk plaques （53.33 %）.In the control group,13 cases with low-risk plaques （43.33%）,6 cases with middle-risk plaques （20.00%）,11 cases with high-risk plaques （36.67%）.The number of intraplaque hemorrhage were 18 cases （60.00%） in the observation group,and 8 cases （26.67%） in the control group.The number of fibrouscap rupture were 21 cases （70.00%） in the observation group,and 13 cases （43.33%） in the control group.Risk stratification of vulnerable plaques in cerebral atherosclerosis （U =-2.032,P =0.042）,intraplaque hemorrhage （χ2 =6.79,P =0.009） and fibrouscap rupture （χ2 =4.34,P =0.037） in the observation group was higher than that in the control group.The number of inflammatory cells in plaques and the density of the new blood vessels in the observation group was （0.188 ± 0.265）Ktrans/min,which in the control group was （0.118 ± 0.183）Ktrans/min.The number of inflammatory cells in the plaque and the density of the new blood vessels in the observation group was higher than that in the control group （t =11.831,P =0.000）.Conclusion

关 键 词：磁共振成像 脑血管障碍 同型半胱氨酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]