CAJ | 학술논문

血浆高半胱氨酸水平与缺血性卒中患者颅内外动脉狭窄的相关性
혈장고반광안산수평여결혈성졸중환자로내외동맥협착적상관성
Correlation between plasma homocysteine level and intra/extracranial stenosis in patients with ischemic Stroke

万方数据

国际脑血管病杂志國際腦血管病雜誌 국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2015年 1期 21-26 ,共6页

胡中文%李敏%魏薇%曾庆宏%庄爱霞%姜建东

호중문%리민%위미%증경굉%장애하%강건동

卒中%脑缺血%脑血管障碍%颅内动脉硬化%高半胱氨酸%危险因素卒中%腦缺血%腦血管障礙%顱內動脈硬化%高半胱氨痠%危險因素
졸중%뇌결혈%뇌혈관장애%로내동맥경화%고반광안산%위험인소
Stroke%Brain Ischemia%Cerebrovascular Disorders%Intracranial Arteriosclerosis%Homocysteine%Risk Factors

目的探讨血浆高半胱氨酸(homocysteine,Hcy)水平与缺血性卒中患者颅内外动脉狭窄的相关性.方法收集缺血性卒中患者的病史、基线临床资料、影像学检查和Hcy等实验室检查结果,根据磁共振血管造影检查结果分为动脉狭窄组和非狭窄组,动脉狭窄组进一步分为单纯颅内动脉狭窄组、单纯颅外动脉狭窄组和颅内外动脉同时狭窄组,分析血浆Hcy水平与颅内外动脉狭窄的相关性.结果共纳入147例缺血性卒中患者,其中动脉狭窄组115例,非狭窄组32例.狭窄组年龄(-4.577,p＜0.001)、Hcy(t=3.65,p＜0.001)、C-反应蛋白(t=2.06,P=0.041)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)(t=1.896,P=0.046)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)(t--4.261,P＜0.001)水平以及糖尿病(x2=5.772,P=o.016)、高血压(x2=10.507,P=0.001)和吸烟(x2=12.282,P＜0.001)的患者构成比与非狭窄组差异存在统计学意义.多变量logistic回归分析显示,年龄≥60岁[优势比(odds ratio,OR)3.374,95％可信区间(confidence interval,CI)1.351 ～ 8.426;P=0.009]、Hcy＞ 15 μmol/L(OR 2.274,95％ CI1.147 ～8.173;P =0.025)、高血压(OR 5.782,95％ CI2.045 ～16.345;P=0.001)、吸烟(OR 3.514,95％ CI1.200～ 10.293;P=0.022)是颅内外动脉狭窄的独立危险因素,而HDL-C＞ 1.0 mmol/L是颅内外动脉狭窄的独立保护因素(OR0.166,95％ CI0.054～0.511;P=0.002).狭窄组根据狭窄部位再分为单纯颅外动脉狭窄组(24例)、单纯颅内动脉狭窄组(61例)、颅内外动脉同时狭窄组(30例).3组间临床资料和危险因素比较显示,高血压的患者构成比(x2=7.024,P=0.003)以及LDL-C(F=3.276,P=0.042)和C-反应蛋白(F=3.645,P=0.029)水平差异有统计学意义.多变量logistic回归分析显示,高血压是单纯颅内狭窄(OR 3.795,95％ CI1.261～11.424;P=0.018)、单纯颅外狭窄(OR18.490,95％ CI3.117～ 10.966;P=0.001)和颅内外动脉同时狭窄(OR 9.178,95 ％CI2.211～38.094;P =0.002)的共同独立危险因素,而HDL-C水平增高是单纯颅内狭窄(OR 0.150,95％ CI0.043 ～0.523;P =0.003)、单纯颅外动脉狭窄(OR 0.078,95％ CI0.012～0.488;P=0.006)和颅内外动脉同时狭窄(OR 0.089,95％ CI0.021～0.385;P=0.001)共同的独立保护因素;年龄为单纯颅内动脉狭窄的独立危险因素(OR 6.351,95％ CI2.277～ 17.717;P＜0.001),LDL-C水平增高为单纯颅外动脉狭窄的独立危险因素(OR 6.021,95％ CI1.212～29.917;P=0.028),Hcy水平增高为单纯颅外动脉狭窄(OR 4.376,95％ CI1.026 ～ 18.671;P=0.046)以及颅内外动脉同时狭窄(OR4.951,95％ CI1.378～17.783;P=0.014)的独立危险因素.结论血浆Hcy水平升高与颅外动脉狭窄相关.
목적 탐토혈장고반광안산(homocysteine,Hcy)수평여결혈성졸중환자로내외동맥협착적상관성.방법 수집결혈성졸중환자적병사、기선림상자료、영상학검사화Hcy등실험실검사결과,근거자공진혈관조영검사결과분위동맥협착조화비협착조,동맥협착조진일보분위단순로내동맥협착조、단순로외동맥협착조화로내외동맥동시협착조,분석혈장Hcy수평여로내외동맥협착적상관성.결과 공납입147례결혈성졸중환자,기중동맥협착조115례,비협착조32례.협착조년령(-4.577,p＜0.001)、Hcy(t=3.65,p＜0.001)、C-반응단백(t=2.06,P=0.041)、저밀도지단백담고순(low-density lipoprotein cholesterol,LDL-C)(t=1.896,P=0.046)、고밀도지단백담고순(high-density lipoprotein cholesterol,HDL-C)(t--4.261,P＜0.001)수평이급당뇨병(x2=5.772,P=o.016)、고혈압(x2=10.507,P=0.001)화흡연(x2=12.282,P＜0.001)적환자구성비여비협착조차이존재통계학의의.다변량logistic회귀분석현시,년령≥60세[우세비(odds ratio,OR)3.374,95％가신구간(confidence interval,CI)1.351 ～ 8.426;P=0.009]、Hcy＞ 15 μmol/L(OR 2.274,95％ CI1.147 ～8.173;P =0.025)、고혈압(OR 5.782,95％ CI2.045 ～16.345;P=0.001)、흡연(OR 3.514,95％ CI1.200～ 10.293;P=0.022)시로내외동맥협착적독립위험인소,이HDL-C＞ 1.0 mmol/L시로내외동맥협착적독립보호인소(OR0.166,95％ CI0.054～0.511;P=0.002).협착조근거협착부위재분위단순로외동맥협착조(24례)、단순로내동맥협착조(61례)、로내외동맥동시협착조(30례).3조간림상자료화위험인소비교현시,고혈압적환자구성비(x2=7.024,P=0.003)이급LDL-C(F=3.276,P=0.042)화C-반응단백(F=3.645,P=0.029)수평차이유통계학의의.다변량logistic회귀분석현시,고혈압시단순로내협착(OR 3.795,95％ CI1.261～11.424;P=0.018)、단순로외협착(OR18.490,95％ CI3.117～ 10.966;P=0.001)화로내외동맥동시협착(OR 9.178,95 ％CI2.211～38.094;P =0.002)적공동독립위험인소,이HDL-C수평증고시단순로내협착(OR 0.150,95％ CI0.043 ～0.523;P =0.003)、단순로외동맥협착(OR 0.078,95％ CI0.012～0.488;P=0.006)화로내외동맥동시협착(OR 0.089,95％ CI0.021～0.385;P=0.001)공동적독립보호인소;년령위단순로내동맥협착적독립위험인소(OR 6.351,95％ CI2.277～ 17.717;P＜0.001),LDL-C수평증고위단순로외동맥협착적독립위험인소(OR 6.021,95％ CI1.212～29.917;P=0.028),Hcy수평증고위단순로외동맥협착(OR 4.376,95％ CI1.026 ～ 18.671;P=0.046)이급로내외동맥동시협착(OR4.951,95％ CI1.378～17.783;P=0.014)적독립위험인소.결론 혈장Hcy수평승고여로외동맥협착상관.
Objective To investigate the correlation between the plasma homocysteine (Hcy) level and intra/extracranial artery stenosis in patients with ischemic stroke.Methods The medical history,baseline clinical data,imaging and Hcy and other laboratory test results in patients with ischemic stroke were collected.The patients were divided into either a stenosis group or a non-stenosis group according to magnetic resonance angiography.The artery stenosis group was further redivided into an isolated intracranial stenosis group,an isolated extracranial stenosis group,and combined extracranial and intracranial stenosis group.The relationship between plasma Hcy level and intra/extracranial stenosis was analyzed.Results A total 147 patients with ischemic stroke were enrolled,including 115 patients in the stenosis group and 32 in the non-stenosis group.There were significant differences in age (t =4.577,P ＜ 0.001),the plasma levels of Hcy (t =3.65,P ＜ 0.001),C-reactive protein (t =2.06,P =0.041),low-density lipoprotein cholesterol (LDL-C) (t =1.896,P =0.046),high-density lipoprotein cholesterol (HDL-C) (t =-4.261,P ＜ 0.001),as well as the proportions of diabetes mellitus (x2 =5.772,P =0.016),hypertension (x2 =10.507,P =0.001) and smoking (x2 =12.282,P ＜ 0.001) between the stenosis group and the non-stenosis group.Multivariate logistic regression analysis showed that age ≥60 years (odds ratio [OR] 3.374,95％ confidence interval [CI] 1.351-8.426; P=0.009),Hcy ＞15 mmol/L (OR 2.274,95％ CI 1.147-8.173; P=0.025),hypertension (OR 5.782,95％ CI 2.045-16.345; P =0.001),and smoking (OR 3.514,95％ CI 1.200-10.293; P=0.002) were the independent risk factors,while HDL-C ＞ 1.0 mmol/L was an independent protective factor for intra/extracranial stenosis (OR 0.166,95％ CI 0.054-0.511; P =0.002).The stenosis group was redivided into an isolated extracranial stenosis group (n =24),an isolated intracranial stenosis group (n =61) and a combined extracranial and intracranial stenosis (n =30) according to the sites of stenosis.The comparison of the clinical data and risk factors among the three groups showed that there were significant differences in the proportions of patients with hypertension (x2 =7.024,P=0.003),as well as the plasma levels of LDL-C (F =3.276,P =0.042) and C-reactive protein (F =3.645,P =0.029).Multivariate logistic regression analysis showed that hypertension was the common independent risk factor for isolated intracranial stenosis (OR 3.795,95％ CI 1.261-11.424; P =0.018),isolated extracranial artery stenosis (OR 18.490,95％ CI 3.117-10.966; P=0.001) and combined extracranial and intracranial stenosis (OR 9.178,95％ CI2.211-38.094; P=0.002),and the increased HDL-C level was the common protective factor for isolated intracranial artery stenosis (OR 0.150,95％ CI 0.043-0.523; P =0.003),isolated extracranial artery stenosis (OR 0.078,95％ CI 0.012-0.488; P=0.006) and combined extracranial and intracranial stenosis (OR 0.089,95％ CI 0.021-0.385; P=0.001).Age was an independent risk factor for isolated intracranial stenosis (OR 6.351,95％ CI 2.277-17.717; P ＜ 0.001).The increased LDL-C level was an independent risk factor for isolated extracranial stenosis (OR 6.021,95％ CI 1.212-29.917; P =0.028).The increased Hcy level was an independent risk factor for isolated extracranial stenosis (OR 4.376,95％ CI 1.026-18.671; P-0.046) and combined extracranial and intracranial stenosis (OR 4.951,95％ CI 1.378-17.783; P =0.014).Conclusions The increased plasma Hcy level correlated with extracranial stenosis.