施惠敏

[摘要] 目的 探討同型半胱氨酸（homocysteine，Hcy）水平对脑梗死患者脑动脉狭窄程度和硬化状况的影响。 方法 选取2019年1月～2019年12月在我院诊治的脑梗死患者82例作为研究对象，根据血浆Hcy的水平，分为观察组（Hcy>15 μmol/L，42例）和对照组（Hcy 5～15 μmol/L，40例），采用磁共振血管成像（Magnetic resonance angiography，MRA）测定血管的狭窄程度并采用彩色多普勒超声仪测定颈动脉斑块硬化程度，并采用Pearson分析Hcy水平与脑动脉狭窄程度和硬化状况的相关性。 结果 与对照组相比，观察组患者的无狭窄率显著降低（7.14% vs 32.50%），重度狭窄率（54.76% vs 30.00%）和总狭窄率（92.86% vs 67.50%）显著升高，差异有统计学意义（P<0.05）;与对照组相比，观察组患者不稳定斑块例数显著升高（59.52% vs 30.00%），差异有统计学意义（P<0.05）;Pearson相关性分析结果显示，Hcy水平与脑动脉狭窄程度和硬化状况呈显著正相关（P<0.05）。 结论 血浆Hcy水平与脑梗死患者脑动脉狭窄程度及动脉粥样硬化状况密切相关，临床应密切关注。

[关键词] 脑梗死;同型半胱氨酸;硬化状况;狭窄程度

[中图分类号] R743.33          [文献标识码] B          [文章编号] 1673-9701（2020）33-0055-03

[Abstract] Objective To investigate the influence of homocysteine（Hcy） level on the degree of cerebral artery stenosis and cerebral arteriosclerosis in patients with cerebral infarction. Methods 82 patients with cerebral infarction diagnosed and treated in our hospital from January 2019 to December 2019 were selected as the research objects and divided into the observation group（Hcy>15 mol/L， n=42） and the control group（Hcy 5-15 μmol/L， n=40） according to the plasma Hcy level. Magnetic resonance angiography（MRA） was used to determine the degree of vascular stenosis and color Doppler ultrasonography was used to determine the degree of carotid plaque sclerosis. Pearson was used to analyze the correlation between the hcy level and the degree of cerebral artery stenosis and cerebral arteriosclerosis. Results Compared with the control group， the non-stenosis rate in the observation group was significantly lower（7.14% vs 32.50%）， the severe stenosis rate（54.76% vs 30.00%） and the total stenosis rate（92.86% vs 67.50%） were significantly higher， and the differences were statistically significant（P<0.05）. Compared with the control group， the number of unstable plaques in the observation group was significantly higher（59.52% vs 30.00%）， with a statistically significant difference（P<0.05）. Pearson correlation analysis showed that hcy level was significantly positively correlated with the degree of cerebral artery stenosis and cerebral arteriosclerosis（P<0.05）. Conclusion The plasma hcy level is closely related to the degree of cerebral artery stenosis and cerebral arteriosclerosis in patients with cerebral infarction， which should be paid close attention to clinically.

[Key words] Cerebral infarction; Homocysteine; Degree of sclerosis; Degree of stenosis

脑梗死（Cerebral infarction，CI）是脑缺血、缺氧等导致的脑部坏死，具有较高的发病率、致残率和致死率，严重危害患者的生命健康[1-2]。同型半胱氨酸是半胱氨酸和蛋氨酸代谢过程中产生的一种中间产物，研究显示[3-4]，高同型半胱氨酸血症是脑梗死的独立危险因素，其可通过损伤血管内皮细胞，促进血管平滑肌细胞增殖，提高血小板功能，促进血栓形成，同时还能够加速动脉粥样硬化的进程。动脉粥样硬化是一种炎性疾病，是脑梗死的重要病理基础，动脉粥样狭窄程度及硬化状况均可作为预测脑梗死危险性的关键指标，本文旨在探讨Hcy水平对脑梗死患者脑动脉狭窄程度和硬化状况的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2019年1月～2019年12月在我院诊治的脑梗死患者82例作为研究对象，其中男47例，女35例。纳入标准：（1）脑梗死的诊断标准[5]参照中华神经外科学会通过的诊断标准;（2）经CT或MRI检查确诊;（3）年龄>18岁;（4）经医院医学伦理委员会批准;（5）患者及家属知情并同意。排除标……