血浆同型半胱氨酸水平与中国缺血性卒中亚型关系的研究
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摘要
目的测定不同病因分型及发病机制急性脑梗死患者血浆同型半胱氨酸(Hcy)的水平,并探讨其与中国缺血性卒中亚型(CISS分型)的关系。方法连续选取在神经内科住院的发病7 d之内的288例ACI患者作为研究组,并选取300例同期健康体检者作为对照组,测定并比较2组血浆Hcy的水平;根据CISS分型将急性脑梗死患者分为大动脉粥样硬化性脑梗死(LAA)、穿支动脉闭塞性脑梗死(PAD)、心源性脑栓塞(CS)、其他病因型缺血性卒中(OE)以及不明原因性缺血性卒中(UE)组,比较5组间Hcy水平;其中,大动脉粥样硬化性脑梗死组依据发病机制不同,进一步分为动脉到动脉栓塞、低灌注/栓子清除下降、载体动脉堵塞穿支动脉及混合机制组,比较各组间Hcy水平。结果急性脑梗死组血浆Hcy水平与健康对照组比较,差异有统计学意义(P<0.05);LAA型、CS型、PAD型、UE型及OE型脑梗死血浆Hcy水平比较,差异均无统计学意义(P>0.05);进一步将LAA型脑梗死患者分为动脉到动脉栓塞、载体动脉堵塞穿支动脉、低灌注/栓子清除下降及混合机制组血浆Hcy水平,组间比较差异均无统计学意义(P>0.05)。结论高Hcy血症可能作为危险因素参与了急性脑梗死的发病过程,但是其在CISS分型各病因分型及不同发病机制患者间的表达水平无明显差异,提示对CISS分型的判定可能无指导意义。
Objective To detect the levels of plasma homocysteine( Hcy) in patients with acute cerebral infarction( ACI) of different etiological types and pathogenesis mechanism,and to explore the correlation between Chinese ischemic stroke subtype( CISS) and the levels of Hcy. Methods A total of 288 patients with ACI were enrolled s ACI group,at the same time,the other 300 healthy subjects were enrolled as control group. The levels of plasma Hcy were detected and compared between the two groups. According to CISS,all the patients were redivided into large artery atherosclerosis cerebral infarction group( LAA group),cardiogenic cerebral embolism group( CS group),perforator artery obliterans cerebral infarction group( PAD group),other causes cerebral infarction group( OE group),uncertain etiological cerebral infarction group( UE group). Moreover the patients in LAA were further divided into the carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group. The levels of Hcy were observed and compared among the groups. Results The levels of Hcy in ACI group were significantly higher than those in control group[( 19. 82 ± 16. 23) μmol/L VS( 14. 52 ± 4. 81) μmol/L,P < 0. 05]. However there were no significant differences in the plasma levels of Hcy among different types of cerebral infarction including LAA,CS,PAD,UE and OE( P > 0. 05). Moreover there were no significant differences in the plasma levels of Hcy among carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group( P > 0. 05). Conclusion The Hcy may participate in the pathogenesis of ACI,but its there are no significant differences in the expression levels of Hcy among ACI patients with different etiological types and pathogenesis mechanism,which suggests that the evaluation of CISS may have no directive significanc.
Objective To detect the levels of plasma homocysteine( Hcy) in patients with acute cerebral infarction( ACI) of different etiological types and pathogenesis mechanism,and to explore the correlation between Chinese ischemic stroke subtype( CISS) and the levels of Hcy. Methods A total of 288 patients with ACI were enrolled s ACI group,at the same time,the other 300 healthy subjects were enrolled as control group. The levels of plasma Hcy were detected and compared between the two groups. According to CISS,all the patients were redivided into large artery atherosclerosis cerebral infarction group( LAA group),cardiogenic cerebral embolism group( CS group),perforator artery obliterans cerebral infarction group( PAD group),other causes cerebral infarction group( OE group),uncertain etiological cerebral infarction group( UE group). Moreover the patients in LAA were further divided into the carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group. The levels of Hcy were observed and compared among the groups. Results The levels of Hcy in ACI group were significantly higher than those in control group[( 19. 82 ± 16. 23) μmol/L VS( 14. 52 ± 4. 81) μmol/L,P < 0. 05]. However there were no significant differences in the plasma levels of Hcy among different types of cerebral infarction including LAA,CS,PAD,UE and OE( P > 0. 05). Moreover there were no significant differences in the plasma levels of Hcy among carrier artery blockage perforator artery group,artery to artery embolism group,low perfusion/remove emboli group and mixed mechanism group( P > 0. 05). Conclusion The Hcy may participate in the pathogenesis of ACI,but its there are no significant differences in the expression levels of Hcy among ACI patients with different etiological types and pathogenesis mechanism,which suggests that the evaluation of CISS may have no directive significanc.
引文
1张秋霞,于伟涛,朱连建.高同型半胱氨酸血症与脑梗死的相关性分析.中国医药导刊,2013,15:1168-1169.
2 周瑤.高同型半胱氨酸血症与脑梗死及传统危险因素相关性的临床研究.吉林大学,2014.
3 彭小莲.高同型半胱氨酸血症与脑梗塞TOAST亚型关系及治疗研究.中国医药导刊,2012,14:2075-2077.
4 那春燕.高同型半胱氨酸血症与脑梗死相关性分析.大家健康,2014,6:96.
5 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014.中华神经科杂志,2015,48:258-273.
6 Wald DS,Law M,Morris JK.Homocysteine and cardiovascular disease:evidence on causality from a meta-analysis.BMJ,2002,325:1202.
7 Clarke R,Colins R,Lewington S,et al.Homocysteine and risk of ischemic heart disease and stroke:a meta-analysis.JAMA,2002,288:2015-2022.
8 中华医学会神经科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29:379-380.
9 解洪荣,余飞,高伟明,等.卒中及短暂性脑缺血发作二级预防指南(第五部分).中国卒中杂志,2014,9:1024-1040.
10 Accinni R,Campolo L,Bartesaghi S,et al.High-performance liquid chro-matographic determination of total plasma homocysteine with or without intemal standards.J Chromatogr A,1998,828:397-400.
11 Lentz SR,Erger RA,Daya S,et al.Folate dependence of hyperho-mo cysteinemia and vascular dysfunction in cystathionine beta syn these deficient mice.Am J Physiol Heart Circhysio1,2000,279:H970-975.
12 Bern M,Saladino J,Sharp JS.Conversion of methionine intohomocysteic acid in heavily oxidized proteomics samples.Rapid Commun Mass Spectrom,2010,24:768-772.
13 贾会珍,刘玉峰,李维红,等.DL-2-氨基4-磺酸基-丁酸与金属离子相互作用的研究.光谱学与光谱分析,2007,27:1291-1294.
14 Lonn E,Yusuf S,Arnold MJ,et al.Homocysteine lowering with folic acid and bvitamins in vascular disease.N Engl J Med,2006,354:1567-1577.
15 张海彬.高同型半胱氨酸与脑梗死预后的相关性分析.中华高血压杂志,2015,23:509-510.
16 汪桂青,赵松耀,窦海玲.缺血性脑卒中的CISS分型及危险因素分析.中国实用神经疾病杂志,2015,18:81-82.
17 Adams HP,Bendixen BH,Kappel LJ,et al.Classification of subtype of acute Ischemic stroke.Definitions for use in a multicenter clinical trial TOAST Trial of Org 10172 in Acute Stroke Treatment.Stroke,1993,24:35-41.
18 Goldstein LB,Jones MR,Matchar DB,et al.Improving the reli-ability of stroke subgroup classification using the trial of org 10172 in acute stroke treatment(TOAST)critertia.Stroke,2001,32:1091-1097.
19 Gao S,Wang YJ,Xu AD,et al.Chinese ischemic stroke subclassification.Front Neurol,2011,2:6.
20 王兰琴,魏秀娥,荣良群,等.急性脑梗死患者同型半胱氨酸和血脂水平变化及其相关性分析.实用心脑肺血管病杂志,2013,21:21-22.
21 张蓓,周东,何兰英,等.急性脑梗死患者同型半胱氨酸水平和CISS分型的关系.西部医学,2015,27:813-815.
22 吴霖浦,黄永新,陈林坤.同型半胱氨酸及超敏C-反应蛋白与急性脑梗死严重程度及分型的关系.广西医学,2016,38:1285-1286.
23 史哲,吴永辉,王拥军.血清同型半胱氨酸水平与急性脑梗死严重程度及中国缺血性卒中亚型分型的关系.中国动脉硬化杂志,2012,20:846-848.
24 刘利宁,李毓新,吉智,等.急性脑梗死患者CISS分型与血同型半胱氨酸、超敏C反应蛋白的相关性研究.海南医学,2016,27:1747-1749.
25 汪桂青,赵松耀,窦海玲.缺血性脑卒中的CISS分型及危险因素分析.中国实用神经疾病杂志,2015,18:81-82.
26 刘美香,马丽丽,周凤琴,等.急性前循环脑梗死患者血清HCY、PLGF水平变化及其与CISS分型的关系.山东医药,2016,56:52-54.
27 张鸥,丛树艳,肖雪.血浆同型半胱氨酸水平对急性脑梗死严重程度的影响,中华医学峰会暨中华医学会神经病学分会第八届全国中青年神经病学学术会议论文汇编.
2 周瑤.高同型半胱氨酸血症与脑梗死及传统危险因素相关性的临床研究.吉林大学,2014.
3 彭小莲.高同型半胱氨酸血症与脑梗塞TOAST亚型关系及治疗研究.中国医药导刊,2012,14:2075-2077.
4 那春燕.高同型半胱氨酸血症与脑梗死相关性分析.大家健康,2014,6:96.
5 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014.中华神经科杂志,2015,48:258-273.
6 Wald DS,Law M,Morris JK.Homocysteine and cardiovascular disease:evidence on causality from a meta-analysis.BMJ,2002,325:1202.
7 Clarke R,Colins R,Lewington S,et al.Homocysteine and risk of ischemic heart disease and stroke:a meta-analysis.JAMA,2002,288:2015-2022.
8 中华医学会神经科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29:379-380.
9 解洪荣,余飞,高伟明,等.卒中及短暂性脑缺血发作二级预防指南(第五部分).中国卒中杂志,2014,9:1024-1040.
10 Accinni R,Campolo L,Bartesaghi S,et al.High-performance liquid chro-matographic determination of total plasma homocysteine with or without intemal standards.J Chromatogr A,1998,828:397-400.
11 Lentz SR,Erger RA,Daya S,et al.Folate dependence of hyperho-mo cysteinemia and vascular dysfunction in cystathionine beta syn these deficient mice.Am J Physiol Heart Circhysio1,2000,279:H970-975.
12 Bern M,Saladino J,Sharp JS.Conversion of methionine intohomocysteic acid in heavily oxidized proteomics samples.Rapid Commun Mass Spectrom,2010,24:768-772.
13 贾会珍,刘玉峰,李维红,等.DL-2-氨基4-磺酸基-丁酸与金属离子相互作用的研究.光谱学与光谱分析,2007,27:1291-1294.
14 Lonn E,Yusuf S,Arnold MJ,et al.Homocysteine lowering with folic acid and bvitamins in vascular disease.N Engl J Med,2006,354:1567-1577.
15 张海彬.高同型半胱氨酸与脑梗死预后的相关性分析.中华高血压杂志,2015,23:509-510.
16 汪桂青,赵松耀,窦海玲.缺血性脑卒中的CISS分型及危险因素分析.中国实用神经疾病杂志,2015,18:81-82.
17 Adams HP,Bendixen BH,Kappel LJ,et al.Classification of subtype of acute Ischemic stroke.Definitions for use in a multicenter clinical trial TOAST Trial of Org 10172 in Acute Stroke Treatment.Stroke,1993,24:35-41.
18 Goldstein LB,Jones MR,Matchar DB,et al.Improving the reli-ability of stroke subgroup classification using the trial of org 10172 in acute stroke treatment(TOAST)critertia.Stroke,2001,32:1091-1097.
19 Gao S,Wang YJ,Xu AD,et al.Chinese ischemic stroke subclassification.Front Neurol,2011,2:6.
20 王兰琴,魏秀娥,荣良群,等.急性脑梗死患者同型半胱氨酸和血脂水平变化及其相关性分析.实用心脑肺血管病杂志,2013,21:21-22.
21 张蓓,周东,何兰英,等.急性脑梗死患者同型半胱氨酸水平和CISS分型的关系.西部医学,2015,27:813-815.
22 吴霖浦,黄永新,陈林坤.同型半胱氨酸及超敏C-反应蛋白与急性脑梗死严重程度及分型的关系.广西医学,2016,38:1285-1286.
23 史哲,吴永辉,王拥军.血清同型半胱氨酸水平与急性脑梗死严重程度及中国缺血性卒中亚型分型的关系.中国动脉硬化杂志,2012,20:846-848.
24 刘利宁,李毓新,吉智,等.急性脑梗死患者CISS分型与血同型半胱氨酸、超敏C反应蛋白的相关性研究.海南医学,2016,27:1747-1749.
25 汪桂青,赵松耀,窦海玲.缺血性脑卒中的CISS分型及危险因素分析.中国实用神经疾病杂志,2015,18:81-82.
26 刘美香,马丽丽,周凤琴,等.急性前循环脑梗死患者血清HCY、PLGF水平变化及其与CISS分型的关系.山东医药,2016,56:52-54.
27 张鸥,丛树艳,肖雪.血浆同型半胱氨酸水平对急性脑梗死严重程度的影响,中华医学峰会暨中华医学会神经病学分会第八届全国中青年神经病学学术会议论文汇编.