老年痴呆与血浆同型半胱氨酸水平关系的临床研究

目的:探讨血浆同型半胱氨酸(homocysteine,Hcy)水平与老年痴呆的相关性。方法:应用全自动生化分析仪以循环酶法检测90例老年痴呆患者的血浆Hcy浓度,并与30例非痴呆患者作为同龄对照组血浆Hcy浓度进行比较;根据Hachinski缺血指数量表评分将老年痴呆分为阿尔茨海默病(Alzheimer’s disease,AD),混合性痴呆(mixed dementia,MD),血管性痴呆(vascular dementia,VD);根据简易精神状态检查量表(Mini-Mental State Examination,MMSE)评分划分痴呆患者严重程度,分为轻度、中度、重度。结果:AD、MD、VD组血浆Hcy水平均显著高于对照组(P<0.01);不同程度痴呆患者血浆Hcy水平有显著性差异(P<0.05),血浆Hcy浓度越高,认知功能损害的程度越重。结论:高Hcy血症可能是老年期痴呆发病的一个重要危险因素,且认知功能减退的程度与血浆同型半胱氨酸浓度呈正相关。     

血浆hs-CRP和Hcy水平与血管性痴呆患者认知功能的关系

目的:探讨血浆超敏C反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平与血管性痴呆(VD)患者认知功能的相关性。方法:回顾性分析2011年12月-2014年7月间我院100例脑梗死住院患者的临床资料,按诊断结果,将患者分为VD组55例和非VD组45例,另选取同期50例健康体检者为对照组。检测并比较3组血浆hs-CRP和Hcy水平,采用简易精神状态速检表(MMSE)对VD组进行痴呆程度分类,分析其与血浆hs-CRP和Hcy的相关性。结果:血浆Hcy与hs-CRP在3组间差异有统计学意义(P0.05),且VD组、非VD组均显著高于对照组,VD组显著高于非VD组,差异均有统计学意义(P0.05)。随着痴呆程度的加重,MMSE评分逐渐降低,血浆hs-CRP与Hcy水平则逐渐升高,差异有统计学意义(P0.05)。经相关性分析发现,MMSE评分和血浆hs-CRP与Hcy水平均呈负相关(r=-0.672,-0.703,P0.05)。结论:血浆hs-CRP与Hcy水平与VD患者的认知功能负相关,临床加强对两指标的检测对VD的诊断及防治有着重要的临床意义。     

Plasma 24S-hydroxycholesterol (cerebrosterol) is increased in Alzheimer and vascular demented patients

Alzheimer's disease (AD) is characterized by the presence of senile plaques, neurofibrillary tangles, and neuronal cell loss associated with membrane cholesterol release. 24S-hydroxycholesterol (24S-OH-Chol) is an enzymatically oxidized product of cholesterol mainly synthesized in the brain. We tested the hypothesis that plasma levels of this oxysterol could be used as a putative biochemical marker for an altered cholesterol homeostasis in the brain of AD patients. Thirty patients with clinical criteria for AD, 30 healthy volunteers, 18 depressed patients, and 12 patients with vascular dementia (non-Alzheimer demented) were studied. Plasma concentrations of 24S-OH-Chol were assayed by isotope dilution;-mass spectrometry, cholesterol was measured enzymatically, and apolipoprotein E (apoE) was genotyped by polymerase chain reaction and restricted fragment length polymorphism. The concentration of 24S-OH-Chol in AD and non-Alzheimer demented patients was modestly but significantly higher than in healthy controls and in depressed patients. There was no significant difference in the concentrations of 24S-OH-Chol between depressed patients and healthy controls nor between AD and non-Alzheimer demented patients. The apoE straightepsilon4 allele influences plasma 24S-OH-Chol. However, this influence could be completely accounted for by the elevated plasma cholesterol in apoE4 hetero- or homozygotes. Plasma 24S-OH-Chol levels correlated negatively with the severity of dementia. AD and vascular demented patients appear to have higher circulating levels of 24S-OH-Chol than depressed patients and healthy controls. We speculate that 24S-OH-Chol plasma levels may potentially be used as an early biochemical marker for an altered cholesterol homeostasis in the central nervous system. 24S-hydroxycholesterol (cerebrosterol) is increased in Alzheimer and vascular demented patients.     

Lipid Peroxidation and Antioxidant Enzyme Activities in Vascular and Alzheimer Dementias

It has been reported that oxidative stress may play a role in the pathogenesis of dementia of the Alzheimer type (AD) and the cerebral ischemia which causes vascular dementia (VD). We measured malondialdehyde (MDA) levels and superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GR) activities in blood samples from patients with AD and VD and in healthy non-demented controls (CTR) which similar ages to the patients, in order to evaluate the degree of oxidative stress in patients with AD and VD. A sample of 150 subjects consisting of 50 patients with AD; 50 patients with VD and 50 CTR, aged from 65 to 85 years on, was analyzed. Most of the changes observed were in SOD activity and MDA levels. Catalase activity were least affected. Significant differences were observed in SOD and GR activity between males and females in CRT and in patients with AD, but not in VD. We have found a decrease in antioxidant enzymes activities (SOD, CAT, GPx and GR) in patients with AD and VD and significant differences were observed between CRT and AD patients for ages from 65 to 74, 75 to 84 and from 85 years to 94 years in SOD activity and MDA levels (P < 0.001). MDA levels increase with age in VD, AD and CTR. No significant variation with respect to sex were detected, but significant variations in MDA levels were detected between CRT and patients with VD and AD (P < 0.001). We conclude that oxidative stress plays an important role in the brain damage for both AD and VD, being observed higher levels of oxidative stress for AD that for VD.     

动脉介入溶栓术治疗急性脑梗死的临床疗效

目的:探究动脉介入溶栓术对急性脑梗死患者的临床疗效。方法:选择我院收治的急性脑梗死患者43例并随机划分成实验组以及对照组。对照组19例予静脉内尿激酶溶栓,实验组24例予尿激酶动脉内溶栓。比较两组临床疗效、治疗前后血清脑钠肽及Hcy水平的变化。结果:实验组总有效率显著高于对照组,差异具有统计学意义(P0.05)。治疗后,两组患者血清脑钠肽、同型半胱氨酸(Hcy)水平及NIHSS评分均较治疗前降低,且与对照组比较,实验组血管总再通率较高、NIHSS评分、血清脑钠肽及Hcy水平较低,差异具备有统计学意义(P0.05)。结论:动脉介入溶栓术治疗急性脑梗死患者能够有效提高血管再通率、NIHSS评分及临床疗效,推测其与降低患者血清脑钠肽及Hcy水平相关联。     

Evaluation of Selenium,Redox Status and Their Association with Plasma Amyloid/Tau in Alzheimer’s Disease

The aim of the study was to evaluate blood selenium and antioxidants as possible oxidative stress markers in Alzheimer’s disease (AD) along with amyloid β42 (Aβ42) and tau by comparing them with vascular dementia (VD) and age-matched healthy controls. Selenium, total tau, Aβ42, glutathione (GSH) and malondialdehyde (MDA) levels and the activities of antioxidant enzymes were analysed in the blood of AD patients (n?=?30), VD patients (n?=?35) and controls (n?=?40) from South India. Plasma Aβ42 level was significantly higher (P?<?0.001) in both AD and VD compared to controls. Total tau and tau-to-amyloid ratio were significantly lower in both AD and VD (P?<?0.001), compared to controls, and a significant difference (P?<?0.01 and P?<?0.05, respectively) was also observed between AD and VD. The receiver operating characteristic (ROC) curve-derived cutoff values of <3.5 for tau-to-Aβ42 ratio and <520 pg/ml for total tau showed sensitivity and specificity of around 67–72 % for differentiating AD from VD and around 90 % for AD from controls, indicating that they could serve as reliable AD-specific markers. The MDA levels were significantly higher (P?<?0.001) in both dementia groups along with a significant decrease (P?<?0.001) in reduced GSH levels, indicating elevated oxidative stress and altered redox status in both forms of dementia. Selenium levels did not vary significantly between the three groups. The activity of glutathione peroxidase increased in both AD and VD compared to controls, with a concomitant decrease in glutathione reductase and glucose-6-phospate dehydrogenase (P?<?0.001) activity. The activity of thioredoxin reductase was significantly lower in both patient groups (P?<?0.001) compared to healthy controls. No correlation was observed between selenium and activities of selenoenzymes, tau, Aβ42 or tau-to-Aβ42 ratio, when analysing independently, indicating that blood selenium may not be directly involved in Aβ production and in regulating tau/Aβ42-mediated mechanism in AD. The present study emphasizes the enhanced oxidative stress in AD pathology and plasma tau and tau-to-amyloid ratio as possible markers to differentiate AD from VD. The study also points that blood selenium may not be involved in regulating oxidative stress in AD, and a longitudinal study correlating plasma and cerebrospinal fluid (CSF) selenium and selenoprotein levels is warranted.     

Alzheimer病患者APP及PS1基因表达量的研究

为了检测Alzheimer病（Alzheimer’s disease,AD）患者外周血中淀粉样前体蛋白（Amyloid Precursor Protein, APP）基因及早老素1（Presenilin 1, PS1）基因的表达情况,进而探讨APP及PS1基因的表达与AD的相关性,采用SYBRGreenⅠ的方法对45例AD患者、25例血管性痴呆（vascular dementia, VD）患者及60名正常对照组样本的mRNA进行绝对定量,检测得到APP基因及PS1基因在对照组中的表达水平分别为0.026±0.005 amol/μg cDNA和0.026±0.004 amol/μg cDNA;在AD患者组中的表达量分别为0.044±0.006 amol/μg cDNA和0.051±0.011 amol/μg cDNA;,在VD患者组中的表达水平分别为0.072±0.013 amol/μg cDNA和0.039±0.005 amol/μg cDNA 。经显著性检验,AD患者组APP基因的表达水平上调,t=2.639, P<0.01;PS1基因的表达水平同样呈上调趋势,t=2.173,P<0.05,差异均具有统计学意义。VD患者组APP基因的表达水平上调,t=3.028,P<0.01;PS1基因的表达水平也同样呈上调趋势,t=2.012,P<0.05,均有显著性差异。因此,APP及PS1基因的表达水平的增高并不一定与AD发生特异性关联,而可能与多种导致痴呆的脑部病变发生关联。     

The association of a cystatin C gene polymorphism with late-onset Alzheimer's disease and vascular dementia

A polymorphism in the cystatin C (CST3) gene was suggested to associate with Alzheimer's disease (AD). In the present study we attempted to determine the association between CST3 polymorphism and AD or vascular dementia (VD), and whether such effects are dependent of the APOE4 allele. The polymorphisms of CST3 genotype were determined using polymerase chain reactions (PCR) followed by gel electrophoresis in 124 AD, 70 VD, and 115 control individuals. No statistical difference in CST3B allele frequencies was observed among all three groups. Associations between CST3B/B genotype and AD patients older than 75-year-old, or VD patients younger than 75-year-old were evident. The APOE4 allele alone significantly increased the odds for the developing AD, but not VD. A logistic regression analysis revealed that either CST3 or its interaction with APOE4 were not significant predictors of AD. However, a synergistic association of CST3 and APOE4 alleles was observed in predicting VD patients. These results suggest that CST3 might interact with APOE4 on conferring vascular pathologies.     

维生素D及白细胞介素-6水平在结直肠癌患者预后评估中的价值

目的 探讨维生素D及白细胞介素-6水平在结直肠癌患者预后评估中的价值。方法 选取树兰（杭州）医院2016—2017年经病理学证实的结直肠癌患者45例和同期健康体检者53例,检测患者外周血中维生素D、白细胞介素-6水平。根据检测结果,将结直肠癌患者分为维生素D高表达组和低表达组以及白细胞介素-6高表达组和低表达组,分别比较各组患者临床病理参数,并对患者进行预后评估。结果 结直肠癌患者外周血中维生素D含量为（6.43±3.71）ng/mL,低于健康对照组的（10.21±3.54）ng/mL,（P<0.01）。白细胞介素-6水平为17.5（8.97~42.92）ng/Ml,高于健康对照组的9.15（3.51~13.79）ng/mL,（P<0.01）,且二者在结直肠癌组织中的水平可能具有相关性（χ2=7.4,P<0.01）。维生素D及白细胞介素-6水平与结直肠癌患者是否发生淋巴结核转移、TNM分期和肿瘤浸润深度密切相关。预后分析发现,血清维生素D浓度与患者预后呈正相关,血清白细胞介素-6水平与患者预后呈负相关。结论 维生素D及白细胞介素-6水平与结直肠癌患者预后有关,可作为判断结直肠癌患者预后的新型、有效的生物学指标。     

Clinical and neuroimaging correlates of abnormal short-latency Somatosensory Evoked Potentials in elderly vascular dementia patients: A psychophysiological exploratory study

BACKGROUND: Short Latency Somatosensory Evoked Potentials (SEPs) may serve to the testing of the somatosensory tract function, which is vulnerable and affected in vascular encephalopathy. The aim of the current study was to search for clinical and neuroimaging correlates of abnormal SEPs in vascular dementia (VD) patients. MATERIALS AND METHODS: The study included 14 VD patients, aged 72.93 PlusMinus; 4.73 years, and 10 controls aged 71.20 PlusMinus; 4.44 years. All subjects underwent a detailed clinical examination, blood and biochemical testing, brain MRI and were assessed with the MMSE. SEPs were recorded after stimulation from upper and lower limbs. The statistical Analysis included 1 and 2-way MANCOVAs and Factor analysis RESULTS: The N13 latency was significantly prolonged, the N19 amplitude was lower, the P27 amplitude was lower and the N11-P27 conduction time was prolonged in severely demented patients in comparison to controls. The N19 latency was prolonged in severely demented patients in comparison to both mildly demented and controls. The same was true for the N13-N19 conduction time, and for the P27 latency. Patients with subcortical lesions had all their latencies prolonged and lower P27 amplitude. DISCUSSION: The results of the current study suggest that there are significant differences between patients suffering from VD and healthy controls in SEPs, but these are detectable only when dementia is severe or there are lesions located in the subcortical regions. The results of the current study locate the abnormal SEPs in the white matter, and are in accord with the literature.     

急性脑梗死患者血管内皮功能及同型半胱氨酸水平的变化

目的 探讨急性脑梗死患者的治疗及其血管内皮功能、同型半胱氨酸水平变化。方法 选择延安大学附属医院2015年8月至2016年12月收治的98例急性脑梗死患者为观察组,选择同期进行体检的98例健康者为对照组。对比2组患者血管内皮功能、Hcy水平及治疗前后各项指标的变化情况。结果 治疗前观察组患者FMD、NO、eNOS水平显著低于对照组（t=－11.310、－7.669、－8.883,P0.05）;NIHSS评分下降,BI评分升高（t=10.954、－10.797,P<0.05）。结论 ACI患者血管内皮功能出现障碍,Hcy水平显著升高。叶酸及维生素B12临床疗效显著,可有效缓解血管内皮功能障碍,降低Hcy水平,改善患者预后。     

不同类型脑卒中患者血清同型半胱氨酸水平检测的临床意义

目的:检测不同类型脑卒中患者血清中同型半胱氨酸(Hcy)浓度,探究其临床意义。方法:将2011年2月至2014年10月期间入我院接受治疗的140例脑卒中患者纳入本次研究,作为研究组,其中包含64例脑梗死患者(CI组)、42例脑出血患者(CH组)以及34例短暂性脑缺血发作患者(TIA组),同时以同期135例体检健康者作为对照组。采用循环酶法测定所有研究对象血清Hcy水平,同时采用放射免疫法对其血清内维生素B12、叶酸浓度进行测定。结果:研究组血清Hcy浓度高于对照组,组间差异显著(P0.05);研究组的叶酸及Vit B12低于对照组,组间差异均有统计学意义(P0.05);两组年龄、TC、TG、LDL-C等指标在组间存在差异(P0.05),两组HDL-C差异无统计学意义(P0.05)。CI组、CH组、TIA组血清Hcy水平均高于对照组,差异均有统计学意义(P0.05),但在CI组、CH组、TIA组三组相互对比中,组间差异无统计学意义(P0.05)。进展性脑梗死组血清内Hcy浓度高于完全性脑梗死组,组间数据具有显著差异(P0.05)。不同NIHSS评分患者血清内Hcy浓度不同,评分越高,Hcy浓度越高,两者呈显著正相关关系(P0.05)。回归性相关分析,脑卒中发病危险因素为高Hcy、高总胆固醇、高LDL-C、低叶酸、低Vit B12(P0.05)。结论:脑卒中患者与健康人群血清Hcy水平存在差异,不同类型脑卒中血清Hcy水平存在差异,且血清中同型半胱氨酸水平与脑卒中发病存在相关性,因此可以将血清Hcy作为脑卒中预测、诊断及预后判断的重要指标之一。     

Efficacy of combined medication of nifedipine and magnesium sulfate on gestational hypertension and the effect on PAPP-A,VEGF, NO,Hcy and vWF

ObjectiveTo investigate the effects of combined medication of nifedipine and magnesium sulfate on the blood pressure, pregnancy-associated plasma protein A (PAPP-A), vascular endothelial growth factor (VEGF), nitric oxide (NO), homocysteine (Hcy) and von Willebrand factor (vWF) in gestational hypertension patients.MethodsA total of 220 gestational hypertension patients were enrolled as the subjects, and divided into two groups randomly, i.e. the observation group and the control group. In observation group, patients took combined medication of nifedipine and magnesium sulfate, while those in the control group only took magnesium sulfate for treatment. Clinical efficacy, and the changes in blood pressure, PAPP-A, VEGF, NO, Hcy and vWF before and after treatment were compared between two groups.ResultsIn the observation group and the control group, total effectiveness rates were 92.7% and 70.9%, respectively (p < 0.05). After treatment, we found significant decreases in PAPP-A, VEGF, NO, Hcy and vWF in patients of two groups, with more significant decreases in the observation group (p < 0.05). Incidence rates of the adverse reactions in two groups were 5.5% and 6.4%, respectively, without any statistically significant differences (p > 0.05). In the observation group, patients had fewer complications (p < 0.05).ConclusionCombined medication of magnesium sulfate and nifedipine can decrease the levels of PAPP-A, VEGF, NO, Hcy and vWF in serum as well as the blood pressure of patients with gestational hypertension, with a reduction in incidence rate of complications and improvement in efficacy.     

Alterations in calcium homeostasis as biological marker for mild Alzheimer's disease?

The calcium hypothesis of neurodegenerative disorders such as Alzheimer's disease (AD) suggests that altered cytosolic Ca(2+) levels ( Ca(2+) (i)) and/or disturbances in Ca2+ homeostasis concern cellular mechanisms underlying neuronal pathology. To search for a diagnostic marker of Alzheimer's disease, we measured cytosolic calcium concentrations in platelets of AD patients, age-matched control subjects (AMC), and vascular dementia (VD) patients. The ( Ca(2+) (i)) was determined using long wavelength indicator Fluo-3AM in 21 mild AD patients, 17 AMC, and 23 patients with VD. The basal values of [Ca(2+)](i) were significantly lower in AD compared to AMC. After the addition of 1 mM calcium, the [Ca(2+)](i) markedly increased in platelets of AD compared to AMC and VD. Measurement of calcium homeostasis could provide a very sensitive, but less specific biological marker of AD. These results support the hypothesis that influencing calcium homeostasis may provide a therapeutic strategy in dementia.     

血清CLU、NRG-1水平与血管性痴呆患者认知功能障碍严重程度的关系及对预后的价值分析

摘要 目的：探讨血清簇集素（CLU）、神经调节蛋白-1（NRG-1）水平与血管性痴呆（VD）患者认知功能障碍严重程度的关系及对预后的价值。方法：选择2020年1月到2022年11月新疆医科大学第一附属医院收治的150例VD患者作为VD组。按照认知功能评分将血管性痴呆患者分为轻度痴呆组60例、中度痴呆组48例以及重度痴呆组42例。随访6个月,根据随访结果将VD患者分为预后良好组与预后不良组。另选同期在我院体检的健康志愿者150例作为对照组。比较VD组与对照组的血清CLU、NRG-1水平;对比不同痴呆程度组血清CLU、NRG-1水平。单因素及多因素Logistic分析VD患者预后不良的影响因素;采用受试者工作特征（ROC）曲线分析血清NRG-1、CLU预测VD患者预后不良的价值。结果：VD组血清CLU水平明显高于对照组,而NRG-1水平明显低于对照组（P＜0.05）。中度及重度痴呆组的血清CLU比轻度痴呆组更高,而NRG-1比轻度痴呆组更低（P＜0.05）。重度痴呆组的血清CLU比中度组更高,而NRG-1比中度组更低（P＜0.05）。随访6个月,无失访病例,预后良好组105例,预后不良组45例。单因素分析显示,预后不良组的年龄、CLU、吸烟及合并高脂血症比例均相比预后良好组更高,而NRG-1、MMSE评分、MoCA评分及NIHSS评分均相比预后良好组更低（P＜0.05）。多因素Logistic回归分析显示,血清CLU升高、合并高脂血症和年龄偏大为患者预后不良的危险因素（P＜0.05）,而血清NRG-1升高为患者预后不良的保护因素（P＜0.05）。ROC曲线分析发现,血清NRG-1联合CLU对预后不良预测价值最高。结论：VD患者血清CLU升高,而血清NRG-1明显降低,与痴呆程度有关。血清NRG-1联合CLU对VD患者预后不良具有较高的预测价值,值得临床关注。     

血清同型半胱氨酸及尿酸水平检测对冠心病的临床价值研究

目的:探讨血清同型半胱氨酸(Hcy)和尿酸(UA)水平检测对冠心病的临床价值。方法:选择经冠状动脉造影确诊为冠心病的182例患者,分为以下3组,稳定型心绞痛(SAP)组78例,不稳定型心绞痛(UAP)组56例,急性心肌梗死(AMI)组48例。另外,随机选择单纯性高血压患者60例作为对照组,比较各组血清Hcy和UA水平并分析二者与各临床类型冠心病之间的关系。结果:⑴冠心病组的血清Hcy和UA水平明显高于单纯性高血压组(P0.05);⑵AMI组的血清Hcy和UA水平均明显高于UAP组和SAP组(P0.05);⑶Spearman相关分析显示:在AMl组中血清Hcy和UA水平呈高度正相关(P0.01);⑷Logistic风险回归显示:血清Hcy和血清UA升高是冠心病的危险因素(P0.05),而血清Hcy升高是急性心肌梗死的独立危险因素(P0.05)。结论:高Hcy与高UA血症是冠心病发病的重要危险因素,联合监测二者对预防冠心病尤其是急性心肌梗死具有重要的临床意义。     

中药通窍活血汤联合脑蛋白水解物对老年痴呆患者日常生活能力和血清Hcy、CRP、FA水平的影响

目的:探讨中药通窍活血汤联合脑蛋白水解物对老年痴呆日常生活能力和血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、叶酸(FA)水平的影响。方法:选择2014年1月～2016年12月在我院脑病科神经内科进行诊治的79例老年痴呆患者,随机分为对照组40例和观察组39例。对照组静脉滴注脑蛋白水解物治疗,每次60 mg,每天2次;观察组联合口服中药通窍活血汤治疗,每天服用1剂,早晚分2次温服,每次200 mL。分别于治疗前后采用简易精神状态检查量表(MMSE)对患者的精神状态进行评估,比较两组的临床治疗有效率,治疗前后的日常生活能力情况以及血清Hcy、CRP、FA水平的变化,比较两组在治疗期间不良反应的发生情况。结果:观察组的有效率为92.31%(36/39),明显高于对照组的72.50%(29/40)(P0.05)。两组治疗后的日常生活能力BI、MMSE评分、血清FA水平均较治疗前明显升高(P0.05),且观察组明显高于对照组(P0.05)。两组治疗后的血清Hcy、CRP水平均较治疗前明显降低(P0.05),且观察组明显低于对照组(P0.05)。两组不良反应的发生情况间比较无显著差异(P0.05)。结论:中药通窍活血汤联合脑蛋白水解物对老年痴呆患者具有较为显著的临床效果,安全可靠,可提高其日常生活能力,改善精神状态以及血清Hcy、CRP、FA水平。     

首发缺血性脑卒中患者血清Hcy和EPO水平的变化及临床意义

目的:探究首发缺血性脑卒中患者血清同型半胱氨酸(Hcy)和红细胞生成素(EPO)水平的变化和意义。方法:于2013年10月-2015年4月我科收治的首发缺血性脑卒中患者中随机选取98例作为观察组,另选取同期健康体检者98例作为对照组,检测患者的血小板、血浆纤维蛋白原(Fib)以及血白细胞水平,比较两组血清Hcy、EPO、血小板、Fib及血白细胞水平,使用Logistic回归分析法评价缺血性脑卒中病发的危险因素,采用Spearman法对血清Hcy与EPO间相关性进行分析。结果:观察组的Hcy(23.52±12.15)m IU/L与EPO(34.61±11.25)m IU/L水平显著高于对照组的(10.57±2.18)m IU/L、(17.54±5.83)m IU/L;观察组血小板、血浆纤维蛋白原(fibrinogen,Fib)及血白细胞水平均高于对照组;差异均有统计学意义(均P0.05)。经Logistic回归分析法分析可知,Hcy为缺血性脑卒中病发的独立因素,经Spearman相关性分析显示,首发缺血性脑卒中患者EPO水平与Hcy呈正相关。结论:缺血性脑卒中病发与血清Hcy和EPO水平升高密切相关,且Hcy是导致缺血性脑卒中病发的高危因素。     

肾移植术后患者同型半胱氨酸、肾功能和血脂水平的变化及其相关性分析

目的:分析肾移植术后患者血清的同型半胱氨酸(Hcy)、肾功能和血脂水平的变化和相关性,探讨其在肾移植术后评价肾功能的应用价值。方法:将2013年10月~2016年9月就诊于我院确诊慢性肾衰并进行肾移植手术的300例术后随访患者作为观察组,选择同期健康志愿者100例作为对照组。检测并比较两组Hcy、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。根据观察组患者Hcy水平的不同将其分成Hcy正常组与Hcy异常组,并对比两组患者的血脂指标水平;测定半胱氨酸蛋白抑制剂C(CysC)的水平并计算肾小球滤过率(eGFR);对观察组血清Hcy与eGFR值、血脂指标水平进行相关性分析,并采用Logistic回归分析分析观察组肾移植术后eGFR下降的影响因素。结果:观察组患者的血清Hcy、TC、TG、HDL-C、LDL-C水平均明显高于对照组(P0.05)。Hcy异常组血清LDL-C水平明显高于Hcy正常组,而HDL-C水平明显低于Hcy正常组(P0.05)。观察组患者血清Hcy与eGFR、HDL-C水平呈负相关关系(r=-0.573、-0.414,P0.05);与TG水平呈正相关(r=0.432,P0.05),与TC、LDL-C无相关(P0.05)。多元Logistic回归分析显示,Hcy、TG、LDL-C水平均与患者eGFR下降有关(P0.05)。结论:在肾移植术后,慢性肾衰患者的TG、LDL-C、Hcy水平均升高,且伴有eGFR水平的降低;肾移植术后肾功能的改变与血清TG、LDL-C、Hcy水平相关;检测肾移植患者血脂指标、Hcy的水平可以评估移植肾功能受损情况。     

Mechanisms of homocysteine-induced oxidative stress

Hyperhomocysteinemia decreases vascular reactivity and is associated with cardiovascular morbidity and mortality. However, pathogenic mechanisms that increase oxidative stress by homocysteine (Hcy) are unsubstantiated. The aim of this study was to examine the molecular mechanism by which Hcy triggers oxidative stress and reduces bioavailability of nitric oxide (NO) in cardiac microvascular endothelial cells (MVEC). MVEC were cultured for 0-24 h with 0-100 microM Hcy. Differential expression of protease-activated receptors (PARs), thioredoxin, NADPH oxidase, endothelial NO synthase, inducible NO synthase, neuronal NO synthase, and dimethylarginine-dimethylaminohydrolase (DDAH) were measured by real-time quantitative RT-PCR. Reactive oxygen species were measured by using a fluorescent probe, 2',7'-dichlorofluorescein diacetate. Levels of asymmetric dimethylarginine (ADMA) were measured by ELISA and NO levels by the Griess method in the cultured MVEC. There were no alterations in the basal NO levels with 0-100 microM Hcy and 0-24 h of treatment. However, Hcy significantly induced inducible NO synthase and decreased endothelial NO synthase without altering neuronal NO synthase levels. There was significant accumulation of ADMA, in part because of reduced DDAH expression by Hcy in MVEC. Nitrotyrosine expression was increased significantly by Hcy. The results suggest that Hcy activates PAR-4, which induces production of reactive oxygen species by increasing NADPH oxidase and decreasing thioredoxin expression and reduces NO bioavailability in cultured MVEC by 1) increasing NO2-tyrosine formation and 2) accumulating ADMA by decreasing DDAH expression.