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背景:很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素。目的:探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系,并分析可能影响同型半胱氨酸水平的相关因素。设计:病例-对照实验。单位:浙江大学医学院附属第二医院神经内科。对象:选择2003-01/11在浙江大学医学院附属第二医院的住院患者57例,其中脑卒中57例(脑出血组21例,脑梗死组36例),并以同期到本院作体检的健康人28例作为对照组。方法:所有被试者均晨起空腹抽取静脉血2mL,测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量,并对所有患者进行临床神经功能缺损程度评分,脑出血组患者根据CT摄片计算出每例患者的血肿体积。主要观察指标:①各组被试者血浆同型半胱氨酸水平。②血浆同型半胱氨酸水平与叶酸,维生素B12,临床神经功能缺损程度评分及血肿体积的相关性。结果:57例脑卒中患者和28例健康者全部进入结果分析。①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组([25.2±21.4),(18.3±10.9),(11.5±2.9)μmol/L;(22.8±18.9),(14.7±7.4),(10.8±2.6)μmol/L,P<0.05～0.01]。脑梗死组和脑出血组基本接近(P>0.05)。②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关(r=-0.442,-0.531,P<0.05),与维生素B12水平无显著相关性(r=-0.086,-0.111,P>0.05)。脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性(r=-0.139,P>0.05),脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性(r=0.225,0.425,P>0.05)。结论:高同型半胱氨酸血症是脑梗死和脑出血的危险因素。血浆同型半胱氨酸水平与叶酸水平呈负相关,与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关。
Background: Many studies have shown that hyperhomocysteinemia may be an independent risk factor for stroke. Objective: To investigate the relationship between hyperhomocysteinemia and the occurrence of cerebral infarction and cerebral hemorrhage and to analyze the related factors that may affect the homocysteine level. Design: Case-control experiment. Unit: Second Affiliated Hospital of Zhejiang University, Department of Neurology. PARTICIPANTS: Fifty-seven inpatients were selected at the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2003 to January 2003. Among them, 57 were stroke (21 in cerebral hemorrhage group and 36 in cerebral infarction group) Healthy people 28 cases as a control group. Methods: All subjects were fasting venous blood samples 2mL, determination of plasma homocysteine, vitamin B12, folic acid, creatinine and other content, and all patients with clinical neurological deficit score, cerebral hemorrhage patients according to CT Photographs were calculated for each patient’s hematoma volume. MAIN OUTCOME MEASURES: ① Plasma homocysteine levels of subjects in each group. ② The correlation between plasma homocysteine levels and folic acid, vitamin B12, clinical neurological deficit score and hematoma volume. Results: All 57 stroke patients and 28 healthy subjects were involved in the result analysis. ①The levels of homocysteine in male and female patients with cerebral infarction and cerebral hemorrhage were significantly higher than those in the same sex group ([25.2 ± 21.4], (18.3 ± 10.9) and (11.5 ± 2.9) μmol / L, respectively; (22.8 ± 18.9), (14.7 ± 7.4) and (10.8 ± 2.6) μmol / L respectively, P <0.05 ~ 0.01]. Cerebral infarction group and cerebral hemorrhage group basically close (P> 0.05). ② There was a significant negative correlation between homocysteine level and folic acid level in patients with cerebral infarction and cerebral hemorrhage (r = -0.442, -0.531, P <0.05), but no significant correlation with vitamin B12 level (r = -0.086 , -0.111, P> 0.05). The level of homocysteine in cerebral infarction group was not significantly correlated with the score of clinical neurological deficit (r = -0.139, P> 0.05). The level of homocysteine, the score of clinical neurological deficit and the volume of hematoma in cerebral hemorrhage group No significant correlation (r = 0.225,0.425, P> 0.05). Conclusion: Homocysteinemia is a risk factor for cerebral infarction and cerebral hemorrhage. Plasma homocysteine levels were negatively correlated with folic acid levels, but not with vitamin B12, clinical neurological deficit score and hematoma volume.