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目的:探讨同型半胱氨酸(Hcy)与不同类型脑卒中的关系,并对高Hcy血症成因作初步分析。方法:测定225例缺血性脑卒中和40例出血性脑卒中患者以及85例同龄健康受试者的血浆Hcy水平以及叶酸、维生素B12的浓度,将缺血性卒中按照TOAST分型分为不同临床亚组--动脉粥样硬化性脑血栓形成组,腔隙性脑梗死组,心源性脑栓塞组以及其他或不明原因脑梗死组,并分别与健康组进行对照研究。结果:血浆同型半胱氨酸平均水平在动脉粥样硬化性脑梗死组患者为(16.19±4.35)μmol/L,腔隙性脑梗死患者为(16.89±6.41)μmol/L,心源性脑栓塞组为(18.23±4.83)μmol/L,其他或不明原因脑梗死患者为(17.31±2.56)μmol/L,脑出血组患者为(14.91±4.54)μmol/L,均高于对照组(7.20±7.91)μmol/L,P<0.05;各缺血性卒中组间同型半胱氨酸水平差异无显著性(P>0.05);缺血性卒中组患者血浆同型半胱氨酸水平高于出血性卒中组(P<0.05)。卒中各组叶酸和维生素B12浓度均显著低于对照组(P<0.05)。结论:血浆同型半胱氨酸在不同类型卒中中均升高,高血浆Hcy水平可能是脑卒中的独立危险因素,叶酸和VitB12缺乏可能是导致高Hcy血症的重要原因。
Objective: To investigate the relationship between homocysteine (Hcy) and different types of stroke and to analyze the causes of hyperhomocysteinemia. METHODS: Plasma Hcy levels and concentrations of folic acid and vitamin B12 were measured in 225 patients with ischemic stroke, 40 patients with hemorrhagic stroke, and 85 healthy subjects of the same age. Ischemic stroke was divided into different groups according to the TOAST classification Clinical subgroup - atherosclerotic cerebral thrombosis group, lacunar infarction group, cardioembolic cerebral infarction group and other or unexplained cerebral infarction group, and were compared with the healthy group. Results: The average level of plasma homocysteine was (16.19 ± 4.35) μmol / L in patients with atherosclerotic cerebral infarction and 16.89 ± 6.41 μmol / L in patients with lacunar infarction (18.23 ± 4.83) μmol / L in embolism group, (17.31 ± 2.56) μmol / L in cerebral infarction group and (14.91 ± 4.54) μmol / L in other or unexplained cerebral infarction group, all higher than those in control group (7.20 ± 7.91) μmol / L, P <0.05; there was no significant difference in homocysteine levels between ischemic stroke groups (P> 0.05); plasma homocysteine level was higher in patients with ischemic stroke than in hemorrhage Stroke group (P <0.05). The concentrations of folic acid and vitamin B12 in stroke group were significantly lower than those in control group (P <0.05). CONCLUSION: Plasma homocysteine is elevated in different types of stroke. High plasma homocysteine level may be an independent risk factor for stroke. Folic acid and VitB12 deficiency may be the important causes of hyperhomocysteinemia.