论文部分内容阅读
目的探讨高龄急性脑梗死(acute cerebral infarction,ACI)患者同型半胱氨酸(homocysteine,Hcy)与颈动脉硬化及预后的相关性。方法选取初发性高龄ACI患者118例和同期健康体检者118例,观察其临床特征、血清Hcy水平的变化及颈动脉粥样硬化情况。将高龄ACI患者又分为不稳定性斑块、稳定性斑块和无斑块组;根据血清Hcy水平,分为Hcy>10μmol/L组和Hcy≤10μmol/L组;以改良Rankin量表(modified Rankin scale,m RS)评分,将患者分为预后不良和预后良好组。应用Logistic回归分析脑梗死不良预后的危险因素,Spearman相关分析血清Hcy与美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、m RS及颈动脉内-中膜厚度(intima-media thickness,IMT)的相关性。结果脑梗死组血清Hcy水平及IMT均高于对照组[(19.24±7.86)μmol/L vs(9.12±3.60)μmol/L;(1.27±0.23)mm vs(0.68±0.14)mm,P<0.01]。不稳定性斑块组[(24.10±10.26)μmol/L和(1.46±0.37)mm]及稳定性斑块组[(20.13±7.31)μmol/L和(1.31±0.32)mm]血清Hcy水平及IMT均高于无斑块组[(12.35±4.32)μmol/L和(1.02±0.21)mm],且不稳定性斑块组IMT(1.46±0.37)mm高于稳定性斑块组(1.31±0.32)mm,差异均有统计学意义(P<0.05)。血清Hcy>10μmol/L组入院第1、90天的NIHSS评分、m RS评分>2分比率和IMT均高于Hcy≤10μmol/L组(P<0.05)。预后不良组血清Hcy水平及IMT均高于预后良好组[(25.63±10.58)μmol/L vs(12.18±4.40)μmol/L;(1.39±0.32)mm vs(1.14±0.16)mm,P<0.01]。Logistic回归分析显示,高Hcy(OR=1.346,95%CI:1.163~1.541,P=0.02)、IMT(OR=2.094,95%CI:1.251~3.728,P=0.02)及NIHSS评分(OR=1.443,95%CI:1.176~1.752,P=0.00)是预后不良的独立危险因素。相关分析显示,血清Hcy与NIHSS、m RS及IMT均呈正相关(r=0.538,P=0.04;r=0.514,P=0.05;r=0.726,P=0.00)。结论血清Hcy与NIHSS、m RS及IMT具有良好的相关性,高Hcy可促进高龄急性脑梗死患者颈动脉粥样硬化的发生且患者预后较差。
Objective To investigate the relationship between homocysteine (Hcy) and carotid atherosclerosis and prognosis in elderly patients with acute cerebral infarction (ACI). Methods A total of 118 patients with ACI and 118 healthy controls were enrolled in this study. The clinical features, serum Hcy level and carotid atherosclerosis were observed. According to the level of serum Hcy, Hcy> 10μmol / L group and Hcy≤10μmol / L group were divided into three groups: the modified Rankin scale ( modified Rankin scale, m RS) score, the patients were divided into poor prognosis and good prognosis group. Logistic regression analysis was used to analyze the risk factors for poor prognosis of cerebral infarction. Spearman correlation analysis between serum Hcy and National Institutes of Health Stroke Scale (NIHSS), m RS and intima- media thickness, IMT). Results Serum Hcy level and IMT in cerebral infarction group were significantly higher than those in control group [(19.24 ± 7.86) μmol / L vs (9.12 ± 3.60) μmol / L vs (1.27 ± 0.23) mm vs (0.68 ± 0.14) mm respectively ]. (24.10 ± 10.26) μmol / L and (1.46 ± 0.37) mm in unstable plaque group and Hcy level in stable plaque group (20.13 ± 7.31 μmol / L and (1.31 ± 0.32) mm and (12.35 ± 4.32) μmol / L and (1.02 ± 0.21) mm respectively), and IMT (1.46 ± 0.37) mm in unstable plaque group was higher than that in stable plaque group (1.31 ± 0.32) mm, the differences were statistically significant (P <0.05). NIHSS score, m RS score> 2 points and IMT were higher in Hcy> 10μmol / L group than those in Hcy≤10μmol / L group (P <0.05). The level of serum Hcy and the IMT in the poor prognosis group were significantly higher than those in the good prognosis group [(25.63 ± 10.58) μmol / L vs (12.18 ± 4.40) μmol / L, 1.39 ± 0.32 mm vs 1.14 ± 0.16 mm, P <0.01 ]. Logistic regression analysis showed that high Hcy (OR = 1.346,95% CI: 1.163-1.541, P = 0.02), IMT (OR = 2.094,95% CI 1.251-3.728, P = 0.02) and NIHSS score , 95% CI: 1.176 ~ 1.752, P = 0.00) were independent risk factors for poor prognosis. Correlation analysis showed that serum Hcy was positively correlated with NIHSS, m RS and IMT (r = 0.538, P = 0.04; r = 0.514, P = 0.05; r = 0.726, P = 0.00). Conclusions There is a good correlation between serum Hcy and NIHSS, m RS and IMT. High Hcy can promote the occurrence of carotid atherosclerosis in elderly patients with acute cerebral infarction and the prognosis is poor.