高同型半胱氨酸血症对急性脑梗死患者短期预后的影响

发布时间：2018-06-27 01:57

  本文选题：高同型半胱氨酸血症 + 脑梗死　； 参考：《第四军医大学》2013年硕士论文

【摘要】：研究背景和目的：脑梗死（cerebralinfarction，，CI）是由于各种原因所致局部脑组织区域性血液供应障碍，产生缺血缺氧性坏死病变，导致与病灶相对应的神经功能缺失症状。CI患者发病后短期内肢体瘫痪的康复最为关键，直接影响到远期预后，因此研究CI患者短期预后的主要影响因素，并采取适当的预防措施，对减轻CI患者的肢体瘫痪程度尤为重要。本项研究针对初次发病的CI患者测定其空腹血浆同型半胱氨酸水平，将CI患者分为非HHcy组、轻度HHcy和中度HHcy组，通过测定血浆中VitB12、叶酸和血脂水平，探讨HHcy的可能影响因素；在此基础上，通过改良Rankin量表（MRS）评分，观察经过给予相同方案治疗后，非HHcy组与HHcy组CI患者短期肢体神经功能缺损恢复的情况。 研究方法：以初次发病的CI患者为研究对象，根据血浆同型半胱氨酸水平将CI患者分为非HHcy组和HHcy组，其中HHcy组又分为轻度HHcy组和中度HHcy组。（1）观察非HHcy组、轻度HHcy组和中度HHcy组之间患者叶酸、VitB12及血脂之间的差别，探讨HHcy的相关影响因素；（2）观察非HHcy组和HHcy组入院时及治疗14天后改良Rankin量表（MRS）评分变化情况，探讨HHcy对CI患者短期肢体神经功能缺损恢复的影响。 研究结果：（1）中度HHcy组和轻度HHcy组患者VitB12、Fa和HDL水平较非HHcy组显著降低，且中度HHcy组较轻度HHcy组的水平更低，而各组中TG、TC和LDL无显著差别。（2）入院时非HHcy组和HHcy组MRS评分生活自理（≤2分）人数和不能自理（≥3分）人数的百分比无统计学差异，经相同药物治疗14天后，非HHcy组生活自理人数的百分比较HHcy组显著升高（P0.01），不能自理人数的百分比较HHcy组显著降低（P0.01），非HHcy组中MRS评分改善人数的百分比较HHcy组显著升高（P0.01）。 研究结论：（1）急性CI患者血浆中Hcy水平与VitB12、Fa和HDL水平呈负性相关，而与TG、TC和LDL无明显的相关性。（2）急性CI患者中HHcy显著影响其短期内神经功能缺损症状的康复，降低Hcy水平对于改善CI患者短期预后有重要的临床意义。
[Abstract]:Background and objective: cerebral infarction (CI) is a regional blood supply disorder caused by various causes, resulting in ischemic and hypoxic necrosis. The recovery of limb paralysis in the patients with neurological deficit corresponding to the focus. The recovery of limb paralysis within a short period of time after onset of CI is the most critical, which directly affects the long-term prognosis. Therefore, the main influencing factors of short-term prognosis of CI patients are studied. It is very important to take appropriate preventive measures to reduce the degree of paralysis in CI patients. In this study, fasting plasma homocysteine levels were measured in CI patients with primary onset. Patients with CI were divided into three groups: non-Hcy group, mild HHcy group and moderate HHcy group. The levels of VitB12, folic acid and blood lipids in plasma were determined to explore the possible influencing factors of HHcy. On this basis, the short-term recovery of limb neurological impairment in CI patients of non-Hcy group and HHcy group was observed by modified Rankin scale (Mrs). Methods: according to plasma homocysteine level, CI patients were divided into non-Hcy group and HHcy group. HHcy group was divided into mild Hcy group and moderate Hcy group. (1) Non-Hcy group was observed. The difference of folate VitB12 and serum lipids between mild HHcy group and moderate HHcy group, to explore the related factors of HHcy. (2) to observe the changes of modified Rankin scale (Mrs) score on admission and 14 days after treatment in non-Hcy group and Hcy group. To investigate the effect of HHcy on the recovery of short-term limb nerve function defect in patients with CI. The results showed that: (1) the levels of VitB12Fa and HDL in moderate HHcy group and mild HHcy group were significantly lower than those in non-HHcy group, and the level in moderate HHcy group was lower than that in mild HHcy group. However, there was no significant difference in TGG TC and LDL between the groups. (2) there was no significant difference in the percentage of patients with MRS scores of self-care (鈮

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