同型半胱氨酸对颈动脉粥样硬化影响及其干预探究.docVIP

同型半胱氨酸对颈动脉粥样硬化影响及其干预探究 　 作者:王荔，薛国芳，李光来，连霞 ［摘要］ 目的 探讨脑梗死患者颈动脉病变与血清同型半胱氨酸（Hcy）水平的关系及叶酸、甲钴胺长期干预对其影响。方法 对165例急性脑梗死患者进行血清Hcy的测定及颈动脉超声检查，并按动脉硬化的程度分组，比较不同程度颈动脉粥样硬化患者Hcy水平，部分高Hcy血症患者给予叶酸、甲钴胺干预，随访2年。结果 随着颈动脉病变程度的加重，血清Hcy浓度呈上升趋势，高Hcy血症干预者动脉内中膜厚度明显减小。结论 高Hcy血症对颈动脉粥样硬化的形成起重要作用，长期给予叶酸、甲钴胺干预可能减轻颈动脉粥样硬化。 ［关键词］ 同型半胱氨酸；颈动脉粥样硬化；脑梗死 Effect of homocystein on carotid artery atherosclerosis and its intervention ［Abstract］ Objective To identify the relationship between serum homocysteine and carotid artery atherosclerosis in patients with cerebral infarction and effects of foliate，methylcobalamin.Methods The concentrations of Hcy were determined by means of fluorescence polarization immunoassay and carotid arteries was examined with color Doppler ultrasound in 165 patients with cerebral infarction.The subjects were divided into 4 groups according to the severity of lesion of carotid artery.The concentrations of Hcy were compared in different groups.The patients with hyperhomocysteinemia received foliate and methylcobalamin.Results When lesion of carotid artery became severer，serum Hcy was higher.The intimamedial thicknesses of carotid artery were significantly decreased in patients with hyperhomocysteinemia who received foliate and methylcobalamin for two years.Conclusion Hyperhomocysteinemia may play an important role in development of carotid artery atherosclerosis.The intervention of foliate and methylcobalamin may reduce carotid artery atherosclerosis. ［Key words］ homocysteine;carotid artery atherosclerosis;cerebral infarction 近年来，大规模动物、临床及流行病学研究显示，高同型半胱氨酸（Hcy）血症可能是造成及加速动脉粥样硬化的新的独立危险因素，但高同型半胱氨酸血症致动脉硬化的确切机制尚不清楚。本文旨在研究脑梗死患者Hcy对颈动脉病变的影响及长期干预的结果。 1 对象与方法 1.1 对象 选择2002～2003年在我院神经内科住院、发病3天内的脑梗死患者165例，男104例，女61例，年龄42～81岁，平均（62.35±10.01）岁，诊断均符合第4届全国脑血管病会议制定的诊断标准，均经头颅CT或MRI证实，并排除血液病、肝肾功能不全及甲状腺疾病。其中有高血压病史者62例，糖尿病史者28例。 1.2 方法 1.2.1 血清Hcy的检测 患者入院次日清晨抽空腹肘静脉血2ml，立即送检。采用荧光偏振免疫法测定血清Hcy，所用免疫发光分析仪和试剂由美国雅培公司提供。 1.2.2 颈动脉彩色多普勒超声检测 采用Philips ATL-5000彩色多普勒超声探测仪，探头频率12～5MHz。患者