同型半胱氨酸与急性脑梗死早期神经功能缺损严重程度及预后的关系

doi:10.3969/j.issn.1004-583X.2021.01.007

摘要/Abstract

摘要：

目的同型半胱氨酸(Hcy)是导致脑梗死的主要危险因素,尤其对大动脉粥样硬化型(LAA)脑梗死。本研究对Hcy与LAA脑梗死早期神经功能缺损严重程度及预后之间的关系进行了临床研究。方法选取LAA急性脑梗死患者260例,按照美国国立卫生院卒中量表(NIHSS)评定患者入院时神经功能缺损严重程度(轻度NIHSS≤5分,中重度NIHSS>5分);24小时内检测空腹血清Hcy水平,将患者分为高Hcy组(Hcy≥10 μmol/L)和正常Hcy组(Hcy<10 μmol/L);随访90天记录预后情况,分析血清Hcy水平与急性脑梗死早期神经功能缺损严重程度及预后之间的相关性。结果中重度急性脑梗死患者血清Hcy水平高于轻度急性脑梗死患者(P<0.01);预后不良患者较预后良患者血清Hcy水平显著升高(P<0.01),再经二元Logistic回归分析发现,Hcy水平升高是急性脑梗死早期神经功能缺损严重程度较重的独立危险因素(P<0.01;OR=1.387, 95%Cl:1.245-1.545)同时也是不良预后的独立危险因素(P<0.01;OR=1.478, 95%Cl:1.312-1.666)。结论血清Hcy水平升高可能是LAA型急性脑梗死早期神经功能恶化及预后不良的独立危险因素。

关键词: 同型半胱氨酸, 脑梗塞, 神经功能缺损, 预后

Abstract:

Objective Homocysteine(Hcy) serves as main risk factor for cerebral infarction, especially for large artery atherosclerosis (LAA) cerebral infarction. The relations between Hcy, severity and prognosis of early neurological impairment in patients with LAA were clinically studied. Methods A total of 260 patients with LAA acute cerebral infarction(ACI) were selected, the degree of neurological impairments of patients at admission was evaluated (mild NIHSS≤5 points, moderate to severe NIHSS>5 points) according to the National Institutes of Health Stroke Scale (NIHSS); the fasting serum Hcy level within 24 hours was tested, and the patients were divided into high Hcy group (Hcy≥10 μmol/L) and normal Hcy group (Hcy<10 μmol/L); the follow-up for 90 days was implemented to record the prognosis, the correlation between the serum Hcy level and severity or prognosis of early neurological impairments in ACI was analyzed. Results The serum Hcy level in patients with moderate or severe ACI was higher than that of patients with mild cerebral infarction (P<0.01); The serum Hcy level in patients with poor prognosis was significantly elevated (P<0.01), and binary logistic regression analysis showed that elevated Hcy level was an independent risk factor for higher severity of neurological impairments in early stages of ACI (P<0.01; OR=1.387, 95%Cl: 1.245-1.545) and an independent risk factor for poor prognosis (P<0.01; OR=1.478, 95%Cl: 1.312-1.666). Conclusion Elevated serum Hcy level may be an independent risk factor for early deterioration of neurological function and poor prognosis of LAA in ACI.

Key words: homocysteine, brain infarction, neurological deficit, prognosis

中图分类号:

R743.33

巩涛, 高云, 胡月圆, 王东玉. 同型半胱氨酸与急性脑梗死早期神经功能缺损严重程度及预后的关系[J]. 临床荟萃, 2021, 36(1): 35-38.

Gong Tao, Gao Yun, Hu Yueyuan, Wang Dongyu. Relationship between homocysteine and early neurological impairment severity and prognosis of acute cerebral infarction[J]. Clinical Focus, 2021, 36(1): 35-38.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.01.007

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I1/35

图/表 5

参考文献 22

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项目	严重程度		χ²/t值	P值	预后		χ²/t值	P值
项目	轻度(n=147)	中重度(n=113)	χ²/t值	P值	良(n=151)	不良(n=109)	χ²/t值	P值
男性[例(%)]	86(58.50)	81(71.70)	4.83	<0.05	88(58.30)	79(72.50)	5.56	<0.05
年龄(岁)	65.19±10.13	68.98±11.15	-2.83	<0.01	65.67±10.00	68.46±11.52	-2.08	<0.05
吸烟[例(%)]	49(33.30)	47(41.60)	1.87	>0.05	49(32.50)	47(43.10)	3.09	>0.05
高血压[例(%)]	89(60.50)	80(70.80)	2.95	>0.05	91(60.30)	78(71.60)	3.55	>0.05
糖尿病[例(%)]	55(37.40)	42(37.20)	0.00	>0.05	58(38.40)	39(35.80)	0.19	>0.05
高脂血症[例(%)]	91(61.90)	62(54.90)	1.31	>0.05	92(60.90)	61(56.00)	0.64	>0.05
高Hcy血症[例(%)]	89(60.50)	105(92.90)	35.36	<0.01	91(60.30)	103(94.50)	39.16	<0.01
收缩压(mmHg)	149.68±19.42	154.93±21.92	-2.01	<0.05	150.01±19.64	154.67±21.81	-1.77	>0.05
舒张压(mmHg)	87.10±10.84	87.70±11.07	-0.44	>0.05	86.87±10.61	88.04±11.36	-0.84	>0.05
葡萄糖(mmol/L)	7.32±2.91	7.43±2.98	-0.31	>0.05	7.36±2.97	7.38±2.90	-0.06	>0.05
甘油三酯(mmol/L)	1.81±0.78	1.80±0.84	0.09	>0.05	1.83±0.84	1.77±0.77	0.61	>0.05
胆固醇(mmol/L)	4.29±0.88	4.39±0.74	-1.02	>0.05	4.29±0.90	4.39±0.70	-0.98	>0.05
低密度脂蛋白胆固醇(mmol/L)	2.99±0.79	3.03±0.72	-0.36	>0.05	2.97±0.78	3.06±0.72	-0.95	>0.05
高密度脂蛋白胆固醇(mmol/L)	1.24±0.29	1.20±0.29	1.16	>0.05	1.23±0.29	1.21±0.30	0.55	>0.05

项目	严重程度		χ²/t值	P值	预后		χ²/t值	P值
项目	轻度(n=147)	中重度(n=113)	χ²/t值	P值	良(n=151)	不良(n=109)	χ²/t值	P值
男性[例(%)]	86(58.50)	81(71.70)	4.83	<0.05	88(58.30)	79(72.50)	5.56	<0.05
年龄(岁)	65.19±10.13	68.98±11.15	-2.83	<0.01	65.67±10.00	68.46±11.52	-2.08	<0.05
吸烟[例(%)]	49(33.30)	47(41.60)	1.87	>0.05	49(32.50)	47(43.10)	3.09	>0.05
高血压[例(%)]	89(60.50)	80(70.80)	2.95	>0.05	91(60.30)	78(71.60)	3.55	>0.05
糖尿病[例(%)]	55(37.40)	42(37.20)	0.00	>0.05	58(38.40)	39(35.80)	0.19	>0.05
高脂血症[例(%)]	91(61.90)	62(54.90)	1.31	>0.05	92(60.90)	61(56.00)	0.64	>0.05
高Hcy血症[例(%)]	89(60.50)	105(92.90)	35.36	<0.01	91(60.30)	103(94.50)	39.16	<0.01
收缩压(mmHg)	149.68±19.42	154.93±21.92	-2.01	<0.05	150.01±19.64	154.67±21.81	-1.77	>0.05
舒张压(mmHg)	87.10±10.84	87.70±11.07	-0.44	>0.05	86.87±10.61	88.04±11.36	-0.84	>0.05
葡萄糖(mmol/L)	7.32±2.91	7.43±2.98	-0.31	>0.05	7.36±2.97	7.38±2.90	-0.06	>0.05
甘油三酯(mmol/L)	1.81±0.78	1.80±0.84	0.09	>0.05	1.83±0.84	1.77±0.77	0.61	>0.05
胆固醇(mmol/L)	4.29±0.88	4.39±0.74	-1.02	>0.05	4.29±0.90	4.39±0.70	-0.98	>0.05
低密度脂蛋白胆固醇(mmol/L)	2.99±0.79	3.03±0.72	-0.36	>0.05	2.97±0.78	3.06±0.72	-0.95	>0.05
高密度脂蛋白胆固醇(mmol/L)	1.24±0.29	1.20±0.29	1.16	>0.05	1.23±0.29	1.21±0.30	0.55	>0.05

组别	例数	易损斑块	非易损斑块	内膜增厚
高Hcy组	194	127(65.50)	35(18.00)	32(16.50)
正常Hcy组	66	18(27.30)	30(45.50)	18(27.30)

组别	例数	易损斑块	非易损斑块	内膜增厚
高Hcy组	194	127(65.50)	35(18.00)	32(16.50)
正常Hcy组	66	18(27.30)	30(45.50)	18(27.30)

组别	例数	Hcy( μmol/L)
易损斑块	145	16.23(12.77-23.01)^*#
非易损斑块	65	10.16(8.84-12.38)
内膜增厚	50	11.79(9.37-13.49)
U值		71.221
P值		<0.01