脑梗死患者血清同型半胱氨酸及超敏反应C蛋白水平与颈动脉粥样硬化斑块性质相关
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摘要
目的分析不同颈动脉粥样硬化斑块性质的脑梗死患者血清同型半胱氨酸(Hcy)、超敏反应C蛋白(hs-CRP)水平,以及其与颈内动脉内膜厚度的关系。方法选取2014年1月至2017年11月于本院神经内科接受住院治疗的急性脑梗死患者100例,分别采用酶循环法、免疫散射比浊法检测患者血浆Hcy、hs-CRP水平,根据颈动脉彩超颈内动脉内膜厚度及颈动脉粥样硬化斑块性质,将患者分为无斑块组(28例)、稳定斑块组(30例)与不稳定斑块组(42例),比较3组Hcy、hs-CRP水平,并分析各组Hcy、hs-CRP水平与颈内动脉内膜厚度相关性。结果 3组患者血浆Hcy与hs-CRP水平差异有统计学意义(P<0.05)。不稳定斑块组Hcy、hs-CRP水平较稳定斑块组、无斑块组高,稳定斑块组Hcy、hs-CRP水平较无斑块组高,差异有统计学意义(P<0.05)。溃疡斑块组血浆Hcy、hs-CRP水平低于非溃疡斑块组,差异有统计学意义(P<0.05)。在所有脑梗死患者中,患者血浆Hcy水平与颈内动脉内膜厚度呈正相关,但血浆hs-CRP水平与颈内动脉内膜厚度无相关性。无斑块组血浆Hcy、hs-CRP水平与颈内动脉内膜厚度无相关性;稳定斑块组、不稳定斑块组血浆Hcy、hs-CRP水平与颈内动脉内膜厚度均呈正相关。结论脑梗死患者血浆Hcy、hs-CRP水平与颈动脉斑块的稳定性及中膜厚度密切相关,可能是同型半胱氨酸、超敏反应C蛋白参与脑梗死发病的机制之一。
Objective To analyze the levels of serum homocysteine(Hcy) and hypersensitivity protein C(hs-CRP) in patients with cerebral infarction with different carotid atherosclerotic plaque properties, and their relationship with carotid intima-media thickness. Methods 100 patients with acute cerebral infarction who were hospitalized in our hospital from January 2014 to November 2017 were enrolled. The levels of plasma Hcy and hs-CRP were measured by enzyme circulation method and immunoturbidimetry. According to the carotid artery intima carotid artery intima thickness and the nature of carotid atherosclerotic plaque, the patients were divided into non-plaque group(28 cases), stable plaque group(30 cases) and unstable plaque group(42 cases). For example, the levels of Hcy and hs-CRP in the three groups were compared, and the correlation between Hcy and hs-CRP levels and carotid intima thickness were analyzed. Results There were significant differences in plasma Hcy and hs-CRP levels between the three groups(P<0.05). The levels of Hcy and hs-CRP in unstable plaque group were higher than those in stable plaque group and plaquefree group. The levels of Hcy and hs-CRP in stable plaque group were higher than those in non-plaque group, the difference was statistically significant(P<0.05). The levels of plasma Hcy and hs-CRP in the ulcer plaque group were lower than those in the non-ulcer plaque group, and the difference was statistically significant(P<0.05). In all patients with cerebral infarction, plasma Hcy levels were positively correlated with carotid intimamedia thickness, but plasma hs-CRP levels were not associated with carotid intima-media thickness. There was no correlation between plasma Hcy and hs-CRP levels and carotid intima-media thickness in the plaque-free group. Plasma Hcy and hs-CRP levels were positively correlated with carotid intima-media thickness in the stable plaque group and unstable plaque group. Conclusion The levels of plasma Hcy and hs-CRP in patients with cerebral infarction are closely related to the stability of carotid plaque and the thickness of the media. It may be one of the mechanisms of homocysteine and hypersensitivity protein C involved in the pathogenesis of cerebral infarction.
Objective To analyze the levels of serum homocysteine(Hcy) and hypersensitivity protein C(hs-CRP) in patients with cerebral infarction with different carotid atherosclerotic plaque properties, and their relationship with carotid intima-media thickness. Methods 100 patients with acute cerebral infarction who were hospitalized in our hospital from January 2014 to November 2017 were enrolled. The levels of plasma Hcy and hs-CRP were measured by enzyme circulation method and immunoturbidimetry. According to the carotid artery intima carotid artery intima thickness and the nature of carotid atherosclerotic plaque, the patients were divided into non-plaque group(28 cases), stable plaque group(30 cases) and unstable plaque group(42 cases). For example, the levels of Hcy and hs-CRP in the three groups were compared, and the correlation between Hcy and hs-CRP levels and carotid intima thickness were analyzed. Results There were significant differences in plasma Hcy and hs-CRP levels between the three groups(P<0.05). The levels of Hcy and hs-CRP in unstable plaque group were higher than those in stable plaque group and plaquefree group. The levels of Hcy and hs-CRP in stable plaque group were higher than those in non-plaque group, the difference was statistically significant(P<0.05). The levels of plasma Hcy and hs-CRP in the ulcer plaque group were lower than those in the non-ulcer plaque group, and the difference was statistically significant(P<0.05). In all patients with cerebral infarction, plasma Hcy levels were positively correlated with carotid intimamedia thickness, but plasma hs-CRP levels were not associated with carotid intima-media thickness. There was no correlation between plasma Hcy and hs-CRP levels and carotid intima-media thickness in the plaque-free group. Plasma Hcy and hs-CRP levels were positively correlated with carotid intima-media thickness in the stable plaque group and unstable plaque group. Conclusion The levels of plasma Hcy and hs-CRP in patients with cerebral infarction are closely related to the stability of carotid plaque and the thickness of the media. It may be one of the mechanisms of homocysteine and hypersensitivity protein C involved in the pathogenesis of cerebral infarction.
引文
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[2]吕青松,凡慧慧.急性脑梗死患者同型半胱氨酸、纤维蛋白原及D-二聚体检测的临床价值[J].当代医学,2018,24(15):109-111.
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[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
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[8] Yeo LL, Andersson T, Yee KW, et al. Synchronous car-diocerebral infarction in the era of endovasculartherapy:which to treat first?[J]. J Thromb Throm-bolysis, 2017,44(1):104-111.
[9] Vasileios Rafailidis, Ioannis Chryssogonidis, ThomasTegos, et al. Imaging of the ulcerated carotid ath-erosclerotic plaque:a review of the literature[J].Insights Imaging, 2017,8(2):213-225.
[10]宿阳,李宏丽,潘安莉,等.超声造影评价颈动脉软斑块增强类型与脑梗死的关系分析[J].医学影像学杂志,2017(2):350-353.
[11]王蕾,陈哲萌,陈浩,等.高血压合并脑梗死患者同型半胱氨酸与颈动脉硬化相关性研究[J].中华全科医学,2015,13(8):1270-1272.
[12]刘俊田.动脉粥样硬化发病的炎症机制的研究进展[J].西安交通大学学报(医学版),2015(2):141-152.
[13] Zhao L, Zhai Z, Hou W. Analysis of Carotid color ultraso-nography and high sensitive C-reactive protein in pa-tients with atherosclerotic cerebral infarction[J].Pak J Med Sci, 2016,32(4):931-934.
[2]吕青松,凡慧慧.急性脑梗死患者同型半胱氨酸、纤维蛋白原及D-二聚体检测的临床价值[J].当代医学,2018,24(15):109-111.
[3] Kernan WN, Ovbiagele B, Black HR, et al. Guidelinesfor the prevention of stroke in patients withstroke and transient ischemic attack:a guidelinefor healthcare professionals from the AmericanHeart Association/American Stroke Association[J].Stroke, 2014,45(7):2160-2236.
[4]谷黎丽,田勇武,贺丹.hs-CRP、LDL水平与急性脑梗死关系的研究进展[J].河北医科大学学报,2018(1):112-116.
[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]王倩,张亮.颈动脉粥样硬化斑块与脑梗死关系的高分辨磁共振研究[J].中国实用神经疾病杂志,2017,20(17):85-88.
[7] Rangel-Castilla L, Rajah GB, Shakir HJ, et al. Man-agement of acute ischemic stroke due to tandem oc-clusion:should endovascular recanalization of theextracranial or intracranial occlusive lesion bedone first?[J]. Neurosurg Focus, 2017,42(4):E16.
[8] Yeo LL, Andersson T, Yee KW, et al. Synchronous car-diocerebral infarction in the era of endovasculartherapy:which to treat first?[J]. J Thromb Throm-bolysis, 2017,44(1):104-111.
[9] Vasileios Rafailidis, Ioannis Chryssogonidis, ThomasTegos, et al. Imaging of the ulcerated carotid ath-erosclerotic plaque:a review of the literature[J].Insights Imaging, 2017,8(2):213-225.
[10]宿阳,李宏丽,潘安莉,等.超声造影评价颈动脉软斑块增强类型与脑梗死的关系分析[J].医学影像学杂志,2017(2):350-353.
[11]王蕾,陈哲萌,陈浩,等.高血压合并脑梗死患者同型半胱氨酸与颈动脉硬化相关性研究[J].中华全科医学,2015,13(8):1270-1272.
[12]刘俊田.动脉粥样硬化发病的炎症机制的研究进展[J].西安交通大学学报(医学版),2015(2):141-152.
[13] Zhao L, Zhai Z, Hou W. Analysis of Carotid color ultraso-nography and high sensitive C-reactive protein in pa-tients with atherosclerotic cerebral infarction[J].Pak J Med Sci, 2016,32(4):931-934.