同型半胱氨酸及低密度脂蛋白与颅内外动脉狭窄程度相关性分析
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摘要
目的探讨缺血性脑卒中患者同型半胱氨酸及低密度脂蛋白水平与颅内外动脉狭窄程度的相关性。方法选择2013年1月~2014年12月在我院神经内科诊治的60例缺血性脑卒中患者作为观察组,同时选择60例健康体检者作为对照组。抽血检测血同型半胱氨酸、低密度脂蛋白等相关指标;并行头、颈部CE-MRA检查颅内外动脉血管情况。结果观察组血同型半胱氨酸水平为(18.19±6.23)μmol/L,高于对照组的(11.23±5.46)μmol/L,差异有统计学意义(P<0.05)。按照颅内动脉狭窄程度分为轻、中、重三个亚组。三组的同型半胱氨酸水平均增加,并高于对照组,差异有统计学意义(P<0.05)。同时三个亚组进行两两比较,重度狭窄组血同型半胱氨酸水平升高最明显,差异有统计学意义(P<0.05);而组间低密度脂蛋白水平比较,差异无统计学意义(P>0.05)。血同型半胱氨酸水平与脑血管狭窄程度成正相关(r=0.68,P<0.05)。多元回归分析显示高血压、高同型半胱氨酸水平与脑血管狭窄密切相关。结论血同型半胱氨酸、低密度脂蛋白水平升高是脑血管狭窄的危险因素,高同型半胱氨酸血症与脑血管狭窄高度相关,应及时预防及干预高同型半胱氨酸血症,避免缺血性脑血管病的发生。
Objective To investigate the relationship between homocysteine plus low density lipoprotein levels and intracranial arterial stenosis in patients with ischemic stroke.Methods A total of 60 cases as observation group were selected from patients with ischemic stroke who were treated in department of neurology in our hospital from January 2013 to December 2014.Meanwhile,60 normal were selected as the control group at the same time.The blood samples were tested for homocysteine and low density lipoprotein.Head and neck CE-MRA weral e used to check the vascular condition of intracranial arteries.Results The blood homocysteine level in the observation group was(18.19±6.23) μmol/L,and wihch was higher than that in the control group([11.23±5.46] μmol/L)(P<0.05).The patients in,intracranial artery stenosis group were subdivided into light,medium and severe groups.The homocysteine level in severe stenosis group was statistically significant than that in other two groups(P<0.05).There was no statistical difference in LDL levels between three subgroups(P >0.05).Homocysteine was positively correlated with the degree of cerebral vascular stenosis(r =0.68,P <0.05).Multiple regression analysis showed that hypertension and homocysteine levels were closely related to cerebrovascular stenosis.Conclusion Blood homocysteine and low density lipoprotein level both are risk factors for cerebral vascular stenosis,and high homocysteine is highly correlated with cerebral vascular stenosis.Prevention and intervention for high level of homocysteine should be timely considered to avoid the occurrence of ischemic cerebrovascular disease.
Objective To investigate the relationship between homocysteine plus low density lipoprotein levels and intracranial arterial stenosis in patients with ischemic stroke.Methods A total of 60 cases as observation group were selected from patients with ischemic stroke who were treated in department of neurology in our hospital from January 2013 to December 2014.Meanwhile,60 normal were selected as the control group at the same time.The blood samples were tested for homocysteine and low density lipoprotein.Head and neck CE-MRA weral e used to check the vascular condition of intracranial arteries.Results The blood homocysteine level in the observation group was(18.19±6.23) μmol/L,and wihch was higher than that in the control group([11.23±5.46] μmol/L)(P<0.05).The patients in,intracranial artery stenosis group were subdivided into light,medium and severe groups.The homocysteine level in severe stenosis group was statistically significant than that in other two groups(P<0.05).There was no statistical difference in LDL levels between three subgroups(P >0.05).Homocysteine was positively correlated with the degree of cerebral vascular stenosis(r =0.68,P <0.05).Multiple regression analysis showed that hypertension and homocysteine levels were closely related to cerebrovascular stenosis.Conclusion Blood homocysteine and low density lipoprotein level both are risk factors for cerebral vascular stenosis,and high homocysteine is highly correlated with cerebral vascular stenosis.Prevention and intervention for high level of homocysteine should be timely considered to avoid the occurrence of ischemic cerebrovascular disease.
引文
[1]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(2):154-160.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]Wang T,Wang Q,Wang Z,et al.Diagnostic value of the combined measurement of serum Hcy,serum Cys C and urinary microalbumin in type 2 diabetes mellitus with early complicating diabetic nephropathy[J].ISRN Endocrinol,2013,2013(10):407-452.
[4]Song IU,Kim JS,Park IS,et al.Clinical significance of homocysteine(hcy)on dementia in Parkinson's disease(PD)[J].Arch Gerontol Geriart,2013,57(3):288-291.
[5]Mc Cully KS.Vascular pathology of homocysteinemia;implications for the pathogenesis of arteriosclerosis[J].Am J Pathol,1969,56(1):111-128.
[6]Cui R,Moriyama Y,Koike KA.Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese:the JA CC study[J].Atherosclerosis,2008,198(2):412-418.
[7]Suwanwela NC,Chutinetr A.Risk factors for atherosclerosis of cervicocerebral arteries:intracranial versus extracranial[J].Neuroepidemiology,2003,22(1):37-40.
[8]Koenig W.Fibrin(ogen)in cardiovascular disease:an update[J].Thromb Haemast,2003,89(4):601-609.
[9]Baszczuk A.Kopczynski Z,Thielemann A.Endothelial dysfunction in patients with primary hypertension and hyperhomocysteinemia[J].Postepy Hig Med Dosw(Online),2014,68:91-100.
[10]Tsuda K.Plasma homocysteine levels and endothelial dysfunction in cerebro-and cardiovascular disease in the metabolic syndrome[J].Am J Hypertens,2015,28(12):1489.
[11]Wang XC,Sun WT,Yu CM,et al.ER stress mediates homocysteine-induced endothelial dysfunction:modulation of IKCa and SKCa channels[J].Atherosclerosis,2015,242(1):191-198.
[12]杨同宏.血尿酸、内皮素和同型半胱氨酸检测在急性脑梗死中的应用探讨[J].中国伤残医学,2013,8(10):282-284.
[13]Piao YS,Lu DH,Chen L,et al.Neuropathological findings in intractable epilepsy:435 Chinese cases[J]Brain Pathol,2010,20(5):902-908.
[14]靳松,崔世民,田超,等.16层螺旋CTA血管造影评价颈动脉狭窄影像学研究[J].中国现代神经疾病杂志,2006,6(5):398-403.
[15]张冬青,于勇,王海滨,等.同型半胱氨酸、超敏C反应蛋白、低密度脂蛋白,D-二聚体与脑梗死的关系[J].感染、炎症、修复,2013,10(2):99-101.
[16]冯燕娴,石增刚,汤凤英,等.血清载脂蛋白B、载脂蛋白B/载脂蛋白A1值与冠状动脉病变的相关性分析[J].东南大学学报(医学版),2011,30(4):577-580.
[17]倪立,新薛飞,袁建新,等.血浆同型半胱氨酸、超敏C反应蛋白与脑部大动脉粥样硬化性狭窄的相关性[J].中国微循环,2008,12(6):365-367.
[18]Van der Heyden J,Van Neerven D,Sonker U,et al.Carotid artery stenting and cardiac surgery in symptomatic patients[J].JACC Cardiovasc Interv,2011,4(11):1190-1096.
[19]Alikhan R,Cohen AT,Combe S,et al.Risk factors for venous thromboembolism in hospitalized patients with acute medical illness:analysis of the MEDENOX Study[J].Arch Intern Med,2004,164(9):963-968.
[20]Peralta CA,Kate R,Newman AB,et al.Systolic and diastolic blood pressure,incident cardiovascular events,and death in elderly persons:the role of functional limitation in the cardiovascular health study[J].Hypertension,2014,64(3):472-480.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]Wang T,Wang Q,Wang Z,et al.Diagnostic value of the combined measurement of serum Hcy,serum Cys C and urinary microalbumin in type 2 diabetes mellitus with early complicating diabetic nephropathy[J].ISRN Endocrinol,2013,2013(10):407-452.
[4]Song IU,Kim JS,Park IS,et al.Clinical significance of homocysteine(hcy)on dementia in Parkinson's disease(PD)[J].Arch Gerontol Geriart,2013,57(3):288-291.
[5]Mc Cully KS.Vascular pathology of homocysteinemia;implications for the pathogenesis of arteriosclerosis[J].Am J Pathol,1969,56(1):111-128.
[6]Cui R,Moriyama Y,Koike KA.Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese:the JA CC study[J].Atherosclerosis,2008,198(2):412-418.
[7]Suwanwela NC,Chutinetr A.Risk factors for atherosclerosis of cervicocerebral arteries:intracranial versus extracranial[J].Neuroepidemiology,2003,22(1):37-40.
[8]Koenig W.Fibrin(ogen)in cardiovascular disease:an update[J].Thromb Haemast,2003,89(4):601-609.
[9]Baszczuk A.Kopczynski Z,Thielemann A.Endothelial dysfunction in patients with primary hypertension and hyperhomocysteinemia[J].Postepy Hig Med Dosw(Online),2014,68:91-100.
[10]Tsuda K.Plasma homocysteine levels and endothelial dysfunction in cerebro-and cardiovascular disease in the metabolic syndrome[J].Am J Hypertens,2015,28(12):1489.
[11]Wang XC,Sun WT,Yu CM,et al.ER stress mediates homocysteine-induced endothelial dysfunction:modulation of IKCa and SKCa channels[J].Atherosclerosis,2015,242(1):191-198.
[12]杨同宏.血尿酸、内皮素和同型半胱氨酸检测在急性脑梗死中的应用探讨[J].中国伤残医学,2013,8(10):282-284.
[13]Piao YS,Lu DH,Chen L,et al.Neuropathological findings in intractable epilepsy:435 Chinese cases[J]Brain Pathol,2010,20(5):902-908.
[14]靳松,崔世民,田超,等.16层螺旋CTA血管造影评价颈动脉狭窄影像学研究[J].中国现代神经疾病杂志,2006,6(5):398-403.
[15]张冬青,于勇,王海滨,等.同型半胱氨酸、超敏C反应蛋白、低密度脂蛋白,D-二聚体与脑梗死的关系[J].感染、炎症、修复,2013,10(2):99-101.
[16]冯燕娴,石增刚,汤凤英,等.血清载脂蛋白B、载脂蛋白B/载脂蛋白A1值与冠状动脉病变的相关性分析[J].东南大学学报(医学版),2011,30(4):577-580.
[17]倪立,新薛飞,袁建新,等.血浆同型半胱氨酸、超敏C反应蛋白与脑部大动脉粥样硬化性狭窄的相关性[J].中国微循环,2008,12(6):365-367.
[18]Van der Heyden J,Van Neerven D,Sonker U,et al.Carotid artery stenting and cardiac surgery in symptomatic patients[J].JACC Cardiovasc Interv,2011,4(11):1190-1096.
[19]Alikhan R,Cohen AT,Combe S,et al.Risk factors for venous thromboembolism in hospitalized patients with acute medical illness:analysis of the MEDENOX Study[J].Arch Intern Med,2004,164(9):963-968.
[20]Peralta CA,Kate R,Newman AB,et al.Systolic and diastolic blood pressure,incident cardiovascular events,and death in elderly persons:the role of functional limitation in the cardiovascular health study[J].Hypertension,2014,64(3):472-480.