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目的探讨缺血性脑血管病患者血浆同型半胱氨酸(Hcy)水平与颈动脉粥样硬化斑块的关系。方法选择327例发病时间≤7 d、首次发病的缺血性脑血管病患者,其中脑梗死264例,颈内动脉系统短暂性脑缺血发作(TIA)63例。采用颈动脉彩色多普勒超声检查颈动脉内-中膜厚度(IMT),综合评估患者颈动脉粥样硬化程度及斑块性质。并根据超声结果将患者分为IMT正常组、IMT增厚组、斑块形成组;酶联免疫吸附法测定晨起空腹血浆Hcy浓度。分析血浆Hcy水平与颈动脉粥样硬化斑块的关系。结果①327例患者中,99例为IMT正常,40例为IMT增厚,188例为粥样斑块形成。在188例斑块形成的患者中,易损斑块组82例,非易损斑块组106例。②IMT正常组、IMT增厚组、斑块形成组的血浆Hcy浓度(中位数)分别为13.6、22.3、28.6μmol/L,高同型半胱氨酸血症(HHcy)的发生率分别为40.4%(40/99)、70.0%(28/40)、75.5%(142/188)。除IMT增厚组与斑块形成组间HHcy发生率差异无统计学意义外,3组间观察指标比较差异均有统计学意义(均P<0.05)。③易损斑块组血浆Hcy浓度和HHcy发生率分别为28.9μmol/L和82.9%,高于非易损斑块组的23.4μmol/L和69.8%,差异均有统计学意义,P<0.05。④多因素Logistic回归分析显示,Hcy浓度增高是颈动脉粥样斑块形成的独立危险因素(OR=1.14,95%CI:1.04～1.25)结论随着血浆Hcy水平的升高,颈动脉粥样硬化程度随之升高。HHcy是颈动脉粥样硬化斑块形成的独立危险因素。
Objective To investigate the relationship between plasma homocysteine (Hcy) levels and carotid artery atherosclerotic plaques in patients with ischemic cerebrovascular disease. Methods A total of 327 patients with ischemic cerebrovascular disease who had a first onset of onset ≤7 days were enrolled in this study. Among them, 264 cases were cerebral infarction and 63 cases were transient ischemic attack (TIA) of internal carotid artery. Carotid artery color Doppler ultrasound (IMT) was used to assess carotid atherosclerosis and plaque quality. According to the results of ultrasound, the patients were divided into IMT normal group, IMT thickening group and plaque formation group. The morning fasting plasma Hcy concentration was determined by enzyme-linked immunosorbent assay. The relationship between plasma Hcy level and carotid artery atherosclerotic plaque was analyzed. Results ① Among the 327 patients, 99 were normal IMT, 40 were IMT thickened, and 188 were atherosclerotic plaques. Of the 188 plaque-forming patients, 82 were vulnerable to plaque and 106 were non-vulnerable plaque. ② The plasma concentrations of Hcy (median) in IMT normal group, IMT thickening group and plaque formation group were 13.6,22.3,28.6μmol / L, respectively. The incidence of hyperhomocysteinemia was 40.4 % (40/99), 70.0% (28/40), 75.5% (142/188). Except IMT thickened group and plaque formation group, there was no significant difference in the incidence of HHcy among the three groups (all P <0.05). ③ The plasma concentrations of Hcy and HHcy in the vulnerable plaque group were 28.9μmol / L and 82.9%, respectively, which were significantly higher than those in the non-vulnerable plaque group (23.4μmol / L and 69.8%, P <0.05) . (4) Multivariate Logistic regression analysis showed that the increased concentration of Hcy was an independent risk factor for the formation of carotid atherosclerotic plaque (OR = 1.14, 95% CI: 1.04-1.25) .Conclusion With the increase of plasma Hcy, carotid atherosclerosis The degree of hardening increases accordingly. HHcy is an independent risk factor for the formation of carotid atherosclerotic plaques.