摘要
目的探讨血浆同型半胱氨酸（HCY）的含量与老年脑梗死的关系及药物干预效果。方法选择2011年6月至2013年6月我院收治的老年脑梗死患者68例为脑梗死组，老年健康体检者38例为对照组。测定2组患者血浆HCY、叶酸、维生素B。血肌酐、空腹血糖、三酰甘油、胆固醇、收缩压、舒张压、身高、体质量等各指标的水平，并进行组间比较。同时做颈动脉彩色多普勒超声检查，比较脑梗死纽与对照组的颈动脉硬化情况及与HCY的关系。根据发作情况将脑梗死组分成初发组（32例）和复发组（36例），分别与对照组的HCY水平比较。同时，对脑梗死组患者给予叶酸及维生素B，：进行干预，比较前后HCY水平。结果（1）老年脑梗死患者血浆HCY水平高于对照组（P〈0．05），而血浆叶酸和维生素B】2水平均显著低于正常对照组（P〈0．05）。脑梗死组的血浆HCY水平与叶酸和维生素B12水平均呈负相关（P〈0．05）。Logistic回归分析显示HCY（OR=6．521，P〈0．05）是脑梗死的独立危险因素。（2）脑梗死复发组和初发组血浆HCY水平均显著高于对照组（P〈0．01），颈动脉内膜一中层厚度（IMT）均高于对照组（P〈0．05）；脑梗死复发组血浆HCY水平高于初发组（P〈0．05），但2组间颈动脉IMT值差异无统计学意义。（3）对高HCY患者药物干预3—4周后血HCY显著降低（P〈0．01）。结论高HCY血症是老年脑梗死的一个重要危险因素；血浆HCY水平与颈动脉粥样硬化患者复发性脑梗死可能有关；给予叶酸、维生素B12干预可以有效降低血清HCY水平。
Objective To investigate the correlation between plasma homocysteine （HCY） level and cerebral infarc- tion in the elderly patients, and to investigate the drug interventions. Methods Sixty-eight elderly patients with ce-rebral infarction from June 2011 to June 2013 were collected as the experimental group and another 38 cases of healthy individuals were collected as the control group. Indicators including plasma levels of HCY, folic acid, vitamin B12, serum creatinine （SCR）, fasting blood glucose （FBG）, triglyceride （TG）, total cholesterol （TC）, systolic blood pressure （SBP）, dias- tolic blood pressure （DBP）, height, weight were detected and compared between two groups. Meanwhile, carotid Doppler uhrasonography detection was performed to analyze the correlation between the degree of carotid atherosclerosis and HCY levels within the two groups. Then the experimental group was further divided into primary group （ 32 patients） and recurrent group （36 patients） according to their episodic severity of cerebral infarctions, and the HCY levels were compared between these two groups and control group. And the HCY level in experimental group after drug interventions with folic acid and vi- tamin B12 was detected. Results （1） The plasma level of HCY in the experimental group was higher than that in the control group （P〈0.05）, while the plasma levels of folate （P〈0. 05） and vitamin B12 （P〈0.05） were significantly lower than those in the control group. The plasma levels of HCY were negatively correlated with the levels of folic acid and vitamin B12 （P〈0.05）. Logistic regression analysis showed that HCY level（ OR= 6. 521, P〈O. 05） was an independent risk factor for cerebral infarction. （2） In both the recurrent group and primary group within the experimental group, plasma HCY level （P〈O. 01 ） and carotid IMT （P〈0. 05） were significantly higher than those in the control group; Plasma HCY level in the recurrent group was higher than that in the primary group （P〈O. 05）, but the carotid IMT between the two groups showed no statistical significance. （3） In the patients with high plasma HCY level, the plasma HCY level significantly declined af-ter drug interventions for 3-4 weeks （P〈0. 01 ）. Conclusions Hyperhomocysteinaemia is an important factor for cerebral infarction in the elderly. Plasma HCY level may be related to re-current cerebral infarctions in the patients with carotid atherosclerosis. Drug interventions with folic acid and vitamin B12 can effectively reduce the plasma HCY level.
出处
《实用老年医学》
CAS
2014年第4期290-293,共4页
Practical Geriatrics
