【作者】 黄术良；

【导师】 郭毅；

【作者基本信息】 暨南大学 ， 神经病学， 2009， 硕士

【摘要】 目的研究同型半胱氨酸与急性脑梗死的关系;探讨叶酸、甲钴胺及维生素B6的应用对急性脑梗死伴高同型半胱氨酸血症(HHcy)的影响。方法系统地收集2007年1月至2008年12月我院神经科首发急性脑梗死住院患者544例,所有患者均经头颅CT/MRI确诊为急性脑梗死;对其按照性别、叶酸水平、tHcy水平及TOAST分型进行系统分层研究;将Hcy与叶酸、维生素B12、超敏C反应蛋白及血脂、肌酐等行相关分析及多元线性回归分析:TOAST 3型中具有颞窗而获得大脑中动脉血流参数的病人有192例,对Hcy及脑血管危险因素与大脑中动脉血流动力学参数的关系进行分析。急性脑梗死伴HHcy患者被随机分为治疗组和对照组,两组给予急性脑梗死的标准治疗,治疗组在标准治疗的基础上给予叶酸、甲钴胺和维生素B6口服3个月。分别检测发病72小时内、2周和3个月时的的tHcy、叶酸和维生素B12;终点事件为两组神经功能评分、生活指数及卒中或心血管事件的发生。结果544例急性脑梗死患者按性别分组后,两组间tHcy水平无明显差异;当tHcy＞15umol/l时,患者叶酸水平和维生素B12较低;按TOAST分型后,在1型和2型脑梗死中tHcy水平明显升高。而且tHcy水平与维生素B12、叶酸呈负相关,与肌酐呈正相关;Hcy水平与颈总动脉内膜厚度无明显相关;TOAST 3型脑梗死患者tHcy水平与MCA血流动力学参数的无明显相关性。168例急性脑梗死伴HHcy患者,治疗组应用叶酸、甲钴胺后tHcy水平明显下降;治疗组和对照组在恢复期两组tHcy水平均有下降;治疗组和对照组在三个月时的NIHSS、mRS分级及BI指数无差异,两组卒中复发率及血管性事件的发生率无明显差异。结论tHcy与血叶酸、维生素B12及肌酐相关;TOAST 1型和2型脑梗死急性期Hcy水平升高明显;Hcy与脑梗死患者的颈动脉内膜厚度及大脑中动脉的血流动力学无明显相关;叶酸和甲钴胺及维生素B6能够降低tHcy水平,但不能改善急性脑梗死的预后。更多还原

【Abstract】 Objective To investigate the relationship between homocysteine and acute cerebral infarction, and to explore the effects of treatment of folate,methylcobalamin and vitamin B6 in the acute cerebral infarction patients with hyperhomocysteinemia(HHcy).Methods 544 acute cerebral infarction patients identified by brain MRI/CT were collected between January 2007 to December 2008.The patients were stratified according with their gender,serum folate,tHcy and TOAST respectively;correlation analysis and multiple linear regression analysis were used to determine the relationship between tHcy and HsCRP,serum lipid,folate,vitamin B12,creatinine,et al.There were 192 of TOAST 3 CI patients with adequate temporal acoustical window to analysis the relationship of MCA blood flow parameters and Hcy, vascular risk factors.168 acute cerebral infarction patients with HHcy were randomized divided into the treatment group and control group,all the patients in this two group were treated with the standard treatment program of cerebral infarction;the treatment group,in additional was also treated with folic acid,mecobalamin and vitamin B6 at least three month,the level of plasma Hcy,folate,vitamin B12 in this two group were inspected in two weeks and 3 months.The primary efficacy end points included NIHSS,BI,mRS and recurrence rate of stroke or vascular event at 3 month,。Results:No significant differences in the level of tHcy was found between the two groups divided by sex;the folic acid and vitamin B12 levels were significantly lower in patients with the level of tHcy＞15μmol/l.level of tHcy was negatively correlated with folate,vitamin B12,and positively correlated with creatinine were found;level of were not correlated with IMT in patients of cerebral infaction.There were higher tHcy levels in patients of TOAST 1 and 2.There was no relationship identified between the level of tHcy and the middle cerebral artery hemodynamics in patients of TOAST 3;the level of tHcy in 168 patients with the level of tHcy＞15μmol/L were decreased after 3 month.But more decreased were observed in patients of the treatment group.There were no difference in the Score of NIHSS,BI index and mRS in patients between the treatment and control group after 3 months.Conclusion:level of tHcy was correlated with folate,vitamin B12 and creatinine;higher tHcy level was observed in patients of TOAST 1 and 2;there was no relationship were found between the tHcy and the carotid intima-media thickness,and the hemodynamics of the brain MCA.Obviously effect of treatment of folate and vitamin B12 in decrease tHcy were found in patients of treatment group,but there was no difference were observed in the prognosis in this two groups.更多还原