同型半胱氨酸与不同类型卒中的相关性研究

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。

Relationship between Plasma Homocysteine and Stroke Subtypes

Objective： To study the relationship between homocysteine （Hey） and different stroke subtypes, and possible mecha- nism of hyper-homocysteinemia（Hbcy）. Methods： Homocysteine, vitamin B 12 and folate levels were measured in 225 cerebral infarction patients, 40 cerebral hemorrhage patients and 85 community controls. All cerebral infarction patients were prospectively subdivided ac- cording to the TOAST classification into four groups： atherosclerotic cerebral infarction group, lacunar infarction group, cerebral em- bolism group and group of unknown or other cause. Regression analysis were used to examine the relationship between HHcy and differ- ent stroke subtypes. Results： The plasma Hcy levels were （16.19± 4.35） μmol/L in atherosclerotic cerebral infarction patients, （16.89± 6.41）μmol/L in lacunar infarction, （18.23± 4.83） μmol/L in cerebral embolism group, （17.31± 2.56） μmol/L in the group of other or unknown causes, and （14.91± 4.54） μmol/L in cerebral hemorrhage patients, all higher than that of the control group which is （7.20± 7.91）μmol/L. There was no significant difference between the subgroups of cerebral infarction patients. The plasma Hcy levels in cere- bral infarction patients were higher than that in cerebral hemorrhage patients. Mean plasma B12 and folate levels were lower in ischaemic stroke patients and haemorrhagic stroke patients than in controls. Conclusion： High homocysteine levels are associated to all etiologic stroke subtypes and intracranial hemorrhage. HHcy may be an independent risk factor for stroke. The deficiency of vitamin B 12 and fo- late may be an important factor for HHcy.