同型半胱氨酸与脑卒中患者脑白质病变的相关性研究
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摘要
目的探讨脑卒中患者的血浆同型半胱氨酸(Hcy)水平与脑白质病变(WML)的关系。方法选择急性脑卒中患者11 5例,根据Ylikoski评分,将患者分为重度WML组59例(Ylikoski评分>17分),无或轻度WML组56例(Ylikoski评分≤17分)。测定患者血浆Hcy水平,进行多因素1ogistic回归分析。结果重度WML组患者的年龄、血浆Hcy水平和高血压的比例均高于无或轻度WML组,差异有统计学意义(P<0.05)。剔除年龄等因素影响后,血浆Hcy水平仍是重度WML的独立危险因素(OR=2.959,95%CI:1.164～7.518,P=0.023)。结论高Hcy血症是脑卒中患者出现重度WML的独立危险因素。
Objective To investigate the relationship between plasma homocysteine(Hcy) level and white matter lesion(WML) in stroke patients.Methods In 115 patients with stroke from march 2009 to September 2009 ware analyzed in this study.Severity of WML was evaluated semi-quantitatively with Ylikoski score.The patients were divided into severe WML group(59 cases) and no/ mild WML group(56 cases),and plasma Hcy level was measured.Multivariate logistic regression method was used to analyze the independent risk factors for severe WML.Results Multivariate analysis indicated that age,incidence of hypertension and plasma Hcy level were higher in severe WML group than in no/mild WML group(P<0.05).Plasma Hcy level was shown to be independent risk factor for severe WML in stroke patients(OR=2.959,95%CI:1.164—7.518, P = 0.023) by multivariate logistic regression analysis.Conclusion Hyperhomocysteinemia is an independent risk factor for severe WML in stroke patients.
Objective To investigate the relationship between plasma homocysteine(Hcy) level and white matter lesion(WML) in stroke patients.Methods In 115 patients with stroke from march 2009 to September 2009 ware analyzed in this study.Severity of WML was evaluated semi-quantitatively with Ylikoski score.The patients were divided into severe WML group(59 cases) and no/ mild WML group(56 cases),and plasma Hcy level was measured.Multivariate logistic regression method was used to analyze the independent risk factors for severe WML.Results Multivariate analysis indicated that age,incidence of hypertension and plasma Hcy level were higher in severe WML group than in no/mild WML group(P<0.05).Plasma Hcy level was shown to be independent risk factor for severe WML in stroke patients(OR=2.959,95%CI:1.164—7.518, P = 0.023) by multivariate logistic regression analysis.Conclusion Hyperhomocysteinemia is an independent risk factor for severe WML in stroke patients.
引文
[1]Buyck JF,Dufouil CMazoyer B.et al.Cerebral white matter lesions are associated with the risk of stroke but not with other vascular events;the 3-Chy Dijon Study.Stroke,2009,40: 2327-2331.
[2]Srikanth V,Beare R,Blizzard L,et al.Cerebral white matter lesions,gait,and the risk of incident falls:a prospective population -based study.Stroke,2009,40:175-180.
[3]Verdelho A.Madureira S,Moleiro C,et al.White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study.Neurology,2010,75:160-167.
[4]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges.Lancet Neurology,2010,9:689-701.
[5]Lee SH,Kim BJ,Ryu WS,et al.White matter lesions and poor outcome after intracerebral hemorrhage:a nationwide cohort study.Neurology,2010,74:1502-1 510.
[6]Rost NS,Rahman R,Sonni S,et al.Determinants of white matter hyperintensity volume in patients with acute ischemic stroke.J Stroke Cerebrovasc Dis,2010.19:230-235.
[7]Ylikoski R,Ylikoski A,Erkinjuntti T,et al.White matter changes in healthy elderly persons correlate with attention and speed of mental processing.Arch Neurol,1993,50:818- 824.
[8]Tseng YL,Chang YY,Liu JS,et al.Association of plasma homocysteine concentration with cerebral white matter hyperintensity on magnetic resonance images in stroke patients.J Neurol Sci,2009,284:36-39.
[9]刘义宏,黄一宁.年龄相关性脑白质改变的研究进展.中华老年心脑血管病杂志,2007,9:68-70.
[10]Geerlings Ml,Appelman AP,Vincken KL.et al.Association of white matter lesions and lacunar infarcts with executive functioning:the SMART-MR study.Am J Epidemiol,2009. 170:1147-1155.
[11]Liu YH,You Y,Song T,et al.Impairment of endothelium-dependent relaxation of rat aortas by homocysteine thiofactone and attenuation by captopril.Carcliovasc Pharmacol,2007,50: 155-161.
[12]Knottnerus lLH,Ten Cate H.Lodder J,et al.Endothelial dysfunction in lacunar stroke:a systematic review.Cerebrovasc Dis,2009.27:519-526.
[13]Cui R,Moriyama Y,Koike KA,et al.Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese;The JACC study.Atherosclerosis, 2008,198:412-418.
[14]Kuszczyk M,Gordon-Krajcer W,Lazarewicz JW.Homocys-teine -induced acute excitotoxicity in cerebellar granule cells in vitro is accompanied by PP2A-mediated dephosphorylation of tau.Neurochem Int,2009,55:174180.
[2]Srikanth V,Beare R,Blizzard L,et al.Cerebral white matter lesions,gait,and the risk of incident falls:a prospective population -based study.Stroke,2009,40:175-180.
[3]Verdelho A.Madureira S,Moleiro C,et al.White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study.Neurology,2010,75:160-167.
[4]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges.Lancet Neurology,2010,9:689-701.
[5]Lee SH,Kim BJ,Ryu WS,et al.White matter lesions and poor outcome after intracerebral hemorrhage:a nationwide cohort study.Neurology,2010,74:1502-1 510.
[6]Rost NS,Rahman R,Sonni S,et al.Determinants of white matter hyperintensity volume in patients with acute ischemic stroke.J Stroke Cerebrovasc Dis,2010.19:230-235.
[7]Ylikoski R,Ylikoski A,Erkinjuntti T,et al.White matter changes in healthy elderly persons correlate with attention and speed of mental processing.Arch Neurol,1993,50:818- 824.
[8]Tseng YL,Chang YY,Liu JS,et al.Association of plasma homocysteine concentration with cerebral white matter hyperintensity on magnetic resonance images in stroke patients.J Neurol Sci,2009,284:36-39.
[9]刘义宏,黄一宁.年龄相关性脑白质改变的研究进展.中华老年心脑血管病杂志,2007,9:68-70.
[10]Geerlings Ml,Appelman AP,Vincken KL.et al.Association of white matter lesions and lacunar infarcts with executive functioning:the SMART-MR study.Am J Epidemiol,2009. 170:1147-1155.
[11]Liu YH,You Y,Song T,et al.Impairment of endothelium-dependent relaxation of rat aortas by homocysteine thiofactone and attenuation by captopril.Carcliovasc Pharmacol,2007,50: 155-161.
[12]Knottnerus lLH,Ten Cate H.Lodder J,et al.Endothelial dysfunction in lacunar stroke:a systematic review.Cerebrovasc Dis,2009.27:519-526.
[13]Cui R,Moriyama Y,Koike KA,et al.Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese;The JACC study.Atherosclerosis, 2008,198:412-418.
[14]Kuszczyk M,Gordon-Krajcer W,Lazarewicz JW.Homocys-teine -induced acute excitotoxicity in cerebellar granule cells in vitro is accompanied by PP2A-mediated dephosphorylation of tau.Neurochem Int,2009,55:174180.