缺血性脑血管病患者颈动脉硬化与高同型半胱氨酸血症关系的研究

目的：探讨急性缺血性脑血管病患者颈动脉粥样硬化（CAA）的发病情况及血浆同型半胱氨酸（plasma homocysteine,pHcy）与CAA的相关性。方法：对179例急性缺血性脑血管病患者进行颈部血管彩色多普勒检查并按动脉硬化程度分组,比较不同程度CAA组患者pHcy水平的变化,记录所有患者年龄、性别、吸烟、饮酒、高血压及糖尿病等传统危险因素以及pHcy、血脂等生化指标。结果：①入选患者颈动脉粥样斑块的发生率为59.2%,颈动脉狭窄发生率为9.5%;②高同型半胱氨酸血症与颈动脉粥样硬化呈显著性相关;③高同型半胱氨酸血症组（Hhcy）不稳定斑块率（50%）大于正常同型半胱氨酸血症组不稳定斑块率（28.97%）,两者比较有统计学意义（P〈0.05）;④脑梗死患者Hhcy率（46.28%）大于短暂性脑缺血发作（TIA）患者Hhcy率（27.59%）,两者比较有统计学意义（P〈0.05）。结论：急性缺血性脑血管病患者颈动脉狭窄的发生率较低,但普遍存在颈动脉粥样斑块,Hhcy是CAA的独立危险因素,可能是不稳定斑块的危险因素。

Research on the Relationship between Hyperhomocysteinemia and Carotid Atherosclerosis in Ischemic Stroke Patients

The incidence of carotid atherosclerosis（CAA）in acute ischemic stroke（AIS） and as well as to the re-lationship between CAA and（Hhcy） was studied. The diameter of common carotid arteries and internal carotid ar-teries on both sides were measured by B-mode ultrasound for 179 AIS suffered patients and they were divided in-to A（normal）,B,C and D groups according to the severity of CAA, and made comparison of changes in pHcy lev-el between various severity of CAA patients. The risk factors were recorded in these patients as well as Hcy andlipid. The incidence of carotid artery plaque and carotid artery stenosis in the selected patients is 59.2 % and9.5%, respectively. There was significant positive correlation between Hhcy and severity of CAA. The probabilityof unstable plaque（50%） in Hhcy group is more than that in the normal group（28.97%）, with P ＆lt;0.05. Hhcy ratein cerebral infarction group（46.28%） is more than that intransient ischemic attack group（27.59 %）, with P ＆lt;0.05. AIS patients with a lower incidence of carrotid artery stenosis, but the prevalence of carotid artery plaquemay be the one of the important causes of AIS. Hhcy is an independent risk factor of CAA and also could be forunstable plaque.