脑梗死患者血清同型半胱氨酸变化及机制的探讨  

Serum homocysteine in patients with cerebral infarction

作　　者：刘建珍[1] 曹传洲[1] 赵钧和[1] 傅善基[2] 包承梅[1] 毕大鹏[1] 嵇高德[1] 

机构地区：[1]济南市第二人民医院内科,山东济南250001 [2]山东大学齐鲁医院,山东济南250012

出　　处：《中风与神经疾病杂志》2003年第4期295-298,共4页Journal of Apoplexy and Nervous Diseases

基　　金：济南市科研基金资助项目 ;济科合字 [2 0 0 0 ]第 12 5号

摘　　要：目的　探讨血清同型半胱氨酸 (Homocysteine,HCY)及其代谢相关因子和血脂与脑梗死的关系 ,并观察叶酸、维生素 B6 对 HCY的影响。方法　对 5 9例经 CT或 MRI证实为脑梗死的患者和 2 9例健康对照者 ,采用高效液相色谱法测定血清同型半胱氨酸水平 ,并应用 PCR扩增法检测 CBS基因 T833C多态性。结果　 (1)脑梗死患者血清 HCY浓度 (2 3.0 0± 7.4 6 nmol/ m l)显著高于正常对照组 (12 .4 6± 3.6 0 nmol/ m l) ,两组比较差异显著 (t=8.94 1,P<0 .0 0 1)。 (2 ) CBS基因在患者组发现 7例纯合子突变 ,2 5例杂合子突变 ;对照组 2例纯合子突变 ,3例杂合子突变 ,两组基因型和等位基因频率分布差异有显著意义 ,前者χ2 =11.32 9,P<0 .0 1;后者χ2 =8.86 8,P <0 .0 1。 CBS基因杂合突变者血清 HCY浓度显著高于正常基因者 t=4 .5 6 9,P<0 .0 0 1。 (3)脑梗死患者血脂与 HCY水平无明显相关。 (4)叶酸、维生素 B6 治疗后 ,CBS正常基因型血 HCY下降最为显著。结论　高同型半胱氨酸血症是脑梗死的独立危险因素 ,而 CBS基因 T833C突变及维生素 B6 。Objective To investigate the relationships between serum homocysteine,genetic polymorphisms of cystathionine β synthase(CBS), plasma lipid levels and cerebral infarction.Methods CBS T833C polymorphisms were determined by ARMS and serum homocysteine levels were measured with HPLC in 59 patients with cerebral infarction and 29 controls. Results (1) The mean serum homocysteine level was higher in patients with cerebral infarction than in controls (23.00±7.46 versus 12.46±3.60 μmol/L, t =8.941, P <0.001).(2)CBS genetic homozygous and heterozygous mutations in patients group were 7 and 21,respectively.However,there were 2 and 3 cases in control group,respectively.There were significant differences in the frequencies of genotypes and alleles of the two groups ( P <0.01).Serum homocysteine levels were markedly higher in patients with CBS genetic heterozygous mutation than in patients without ( t =4.569, P <0.001).(3) There was no relationship between serum homocysteine level and plasma lipid level in patients with cerebral infarction. (4) Serum homocysteine level was most remarkably decreased in CBS normal genotype after treatment with folic acid(FA) and vitamin B 6.Conclusion Hyperhomocysteinemia is an independent risk factor for carebrovascular diseases.CBS gene T833C point mutations and absence of FA and B 6 are possibly important mechanism of hyperhomocysteinemia.

关 键 词：脑梗死 血清 同型半胱氨酸 发生机制 高效液相色谱法 危险因素 血脂 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R589.3[医药卫生—临床医学]