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急性脑梗死患者血管内皮功能和同型半胱氨酸水平变化及其治疗

Vascular Endothelial Function and Homocysteine Level in Patients with Acute Cerebral Infarction and Its Treatment

【作者】 邓远琼刘伯胜邓远琪胡志彪刘贞范华胡建新王海荣

【Author】 DENG Yuan-qiong;LIU Bo-sheng;DENG Yuan-qi;Department of Functions,the Fourth Affiliated Hospital of Nanchang University;

【机构】 南昌大学第四附属医院功能科

【摘要】 目的观察急性脑梗死患者血管内皮功能、同型半胱氨酸(Hcy)水平变化,探讨叶酸、维生素B12的治疗作用。方法选择我院2011年1月—2012年10月收治的急性脑梗死患者160例,按是否合并高血压分为脑梗死合并高血压组80例和脑梗死未合并高血压组80例,再采用随机数字表将脑梗死未合并高血压组80例患者分为干预Ⅰ组和非干预Ⅰ组,每组40例;将脑梗死合并高血压组80例患者分为干预Ⅱ组和非干预Ⅱ组,每组40例;选择同期在我院健康体检中心体检健康者80例为对照组。采用彩色超声诊断仪测定肱动脉内径及颈动脉内膜中层厚度(IMT),计算反应性充血后血管内径变化率(FMD);循环酶法测定血清同型半胱氨酸(Hcy)水平;硝酸还原酶法测定血清一氧化氮(NO)水平、酶联免疫吸附试验(ELISA)测定血清内皮型NO合成酶(eNOS)水平。采用美国国立卫生研究院卒中量表(NIHSS)评价干预组治疗前后神经功能缺损程度,采用Barthel指数(BI)评价干预组治疗前后日常生活能力。结果脑梗死合并高血压组和脑梗死未合并高血压组FMD及血清NO、eNOS水平低于对照组(P<0.01),且脑梗死合并高血压组低于脑梗死未合并高血压组(P<0.01);脑梗死合并高血压组和脑梗死未合并高血压组IMT及血清Hcy水平高于对照组(P<0.01),且脑梗死合并高血压组高于脑梗死未合并高血压组(P<0.01)。干预Ⅰ组治疗2周后BI评分及血清NO、eNOS水平高于非干预Ⅰ组,NIHSS评分低于非干预Ⅰ组(P<0.01);干预Ⅰ组治疗12周后BI评分及血清NO、eNOS水平高于非干预Ⅰ组,NIHSS评分及血清Hcy水平低于非干预Ⅰ组(P<0.01)。干预Ⅱ组治疗2周后、治疗12周后BI评分及血清NO、eNOS水平高于非干预Ⅱ组,NIHSS评分及血清Hcy水平低于非干预Ⅱ组(P<0.01)。Spearman等级相关性分析结果显示,脑梗死合并高血压组和脑梗死未合并高血压组患者血清NO水平与血清Hcy水平均呈负相关(r值分别为-0.90和-0.79,P<0.01)。结论急性脑梗死患者存在血管内皮功能障碍及高同型半胱氨酸血症,两者具有协同作用;叶酸、维生素B12可改善急性脑梗死患者血管内皮功能,降低血清Hcy水平,改善患者预后。

【Abstract】 Objective To evaluate the vascular endothelial function and homocysteine(Hcy) level in patients with actue cerebral infarction,and explore the effects of folic acid,Vitamin B 12 on the prognosis of acute cerebral infarction.Methods A total of 160 patients with acute cerebral infarction treated in our hospital from January 2011 to October 2012 were included in this study.The patients were divided into two groups based on their blood pressure,namely the Group Ⅰ of 80 patients with normal blood pressure and Group Ⅱ of 80 patients with hypertension.Each group was divided randomly into two subgroups of 40 patients,namely Group Ⅰ with intervention,Group Ⅰ without intervention,Group Ⅱ with intervention,and Group Ⅱ without intervention.And 80 healthy people who came to our hospital for regular physical examination during the same period were recruited as the control group.The inner diameter of brachial artery,carotid intima-media thickness(IMT) were detected by Color Doppler,and brachial artery flow-mediated dilation(FMD) calculated;Serum Hcy level was determined by enzymatic cycling assay,serum nitrogen oxide( NO) by nitrate reductase method,and the serum level of endothelial nitrogen oxide synthase( eNOS) was measured by enzyme-linked immunosorbent assay( ELISA). The degree of neurological deficits was evaluated by the National Institutes of Health Stroke Scale( NIHSS) of the U. S.,and the ability of daily living was rated with Barthel Index( BI). Results The FMD,levels of NO,eNOS were lower in Group Ⅰwith hypertension than those in Group Ⅱ with normal blood pressure,all of which were lower than those in control group. The levels of Hcy and IMT were higher in Group Ⅰwith hypertension than those in Group Ⅱ with normal blood pressure,all of which were higher than those in control group. The comparison among the four test subgroups showed that,compared to the two subgroups without intervention,the two subgroups with intervention has higher levels of NO,eNOS,and BI,and lower levels of the Hcy( not between GroupⅠ with intervention and GroupⅠ without intervention) and NIHSS after 2 weeks and after 12 weeks of the treatment( P <0. 01). The serum NO levels and serum Hcy levels were negatively correlated in Group Ⅰ with hypertension and Group Ⅱ with normal blood pressure( r =-0. 90,-0. 79; P < 0. 01). Conclusion There are vascular endothelial dysfunction and high Hcy hyperlipidemia in patients with acute cerebral infarction,both of which work synergistically in promoting the atherosclerosis process. Folic acid and vitamin B12can reduce serum Hcy level,enhance the endothelial function,and improve the prognosis of patients with acute cerebral infarction.

【关键词】 脑梗死; 血管内皮; 半胱氨酸; 叶酸; 维生素B12;

【Key words】 Brain infarction; Endothelialium vascular; Cysteine; Folic acid; Vitamin B12;

【分类号】R743.33;R322.12;R341.1;

【基金】 江西省科技计划项目(20122BBG70146)

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