高同型半胱氨酸血症与脑梗死及传统危险因素相关性的临床研究

发布时间：2018-05-04 21:38

  本文选题：高同型半胱氨酸血症 + 脑梗死　； 参考：《吉林大学》2014年硕士论文

【摘要】：脑梗死是一种严重危害人类健康的重要疾病，具有高发病率、高复发率、高致残率和高死亡率的特性，缺血性脑卒中已成为我国死亡率及致残率最高的疾病。脑血管病防治的关键在于预防，对于危险因素的控制尤为重要。一些传统危险因素如高血压、糖尿病、吸烟、饮酒、肥胖、血脂异常等与脑梗死的相关性已被人们熟知，随着研究的深入，众多研究发现，高同型半胱氨酸血症是一个新的脑血管病危险因素。目前国内外关于高同型半胱氨酸血症与脑梗死相关性的研究尚无定论，降低血浆同型半胱氨酸是否能减少脑血管病的发病仍存在争议。本研究选取东北地区脑梗死的病人为研究对象，探讨HHcy与脑梗死及传统危险因素的相关性，旨为缺血性脑血管病的筛查及预防提供新的线索。 本研究选择2012年9月至2013年9月期间吉林大学白求恩第一医院神经内科住院的脑梗死患者为研究对象，，主要做了以下研究：①所有入组脑梗死患者伴有不同程度HHcy所占比例分析。②依据TOAST分型将所有样本1023例分为5组，分别比较各组间HHcy的差异。③根据颈动脉中内膜厚度（IMT）是否增厚分为：IMT增厚组（IMT≥1mm）及IMT正常组（IMT＜1mm），比较2组HHcy的差异。④根据空腹血清Hcy水平分为：HHcy组（Hcy≥15μmol/L）及非HHcy组（Hcy＜15μmol/L），系统分析2组之间性别、年龄、高血压、糖尿病、血脂、吸烟、饮酒的差异。⑤统计分析血清Hcy水平与其主要影响因素叶酸、维生素B12以及饮食习惯之间的相关性。 主要研究结果如下：①所有1023例脑梗死患者68.9%（705/1023）伴有高同型半胱氨酸血症，其中轻度HHcy占67.4%（475/705），中度HHcy占26.1%（184/705），重度HHcy占6.5%（46/705）。②TOAST分型各亚型HHcy的差异：LA组发生HHcy的概率均大于其他各组，差异有统计学意义（P＜0.05）。③IMT增厚组较IMT正常组更易发生HHcy，差异有统计学意义（P＜0.05）。④血清Hcy与叶酸、维生素B12呈线性负相关，叶酸及维生素B12缺乏与HHcy的发生显著相关，经常进食蔬菜可减少HHcy的发生。 结论：①HHcy与脑梗死的发病具有显著相关性。②HHcy与大动脉粥样硬化型脑梗死发生及颈动脉粥样硬化程度显著相关。③血清Hcy浓度与叶酸、维生素B12呈负相关，经常进食蔬菜可减少HHcy的发生。
[Abstract]:Cerebral infarction is an important disease that seriously endangers human health. It has the characteristics of high morbidity, high recurrence rate, high disability rate and high mortality rate. Ischemic stroke has become the disease with the highest mortality and disability rate in China. Prevention is the key to the prevention of cerebrovascular disease, especially for the control of risk factors. Some traditional risk factors, such as high blood pressure, diabetes, smoking, drinking, obesity, dyslipidemia and so on, have been known for their association with cerebral infarction. Hyperhomocysteinemia is a new risk factor for cerebrovascular disease. At present, there is no conclusion on the relationship between hyperhomocysteinemia and cerebral infarction at home and abroad. Whether reducing plasma homocysteine can reduce the incidence of cerebrovascular disease is still controversial. In order to provide new clues for screening and prevention of ischemic cerebrovascular disease, the relationship between HHcy and cerebral infarction and traditional risk factors was studied in patients with cerebral infarction in Northeast China. From September 2012 to September 2013, patients with cerebral infarction in Department of Neurology, Bai Qiuen first Hospital of Jilin University, were selected as subjects. The following research was done: 1 1023 patients with cerebral infarction were divided into 5 groups according to TOAST classification. 2. The proportion of all patients with cerebral infarction with different degrees of HHcy was divided into 5 groups according to TOAST classification. To compare the difference of HHcy between groups according to whether carotid intima thickness (IMT) was thickened or not, divided into two groups: 1: IMT 鈮

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