同型半胱氨酸与老年高血压缺血性脑卒中及其预后的相关性

摘要

Objective:To explore the correlation among severity , prognosis of ischemic stroke (IS) and homocysteine (Hcy) level in aged patients with essential hypertension (EH) .Methods:Clinical data of 135 aged EH patients ,who were diagnosed in our hospital from Jan 2011 to Jan 2013 ,were retrospectively analyzed ,including 45 cases with pure hypertension (EH control group) and 90 cases complicated with IS (EH+IS group) .IS severity was scored ac-cording to Rankin score (mRS) and they were divided into mild group (n=45) and severe group (n=45) .Hcy level was measured in three groups ,and its correlation with IS severity was analyzed .Then 90 EH patients received thera-py ,and they were divided into group A (recieved routine antihypertensive therapy) and group B (received Hcy-con-trol therapy based on routine antihypertensive treatment);after one year ,percentage of IS was compared between two groups .Results:Before treatment ,Hcy levels in severe group and mild group were significantly higher than that of EH control group [ (34.55 ± 4.56)μmol/L vs .(18.88 ± 3.31)μmol/L vs .(15.03 ± 2.43)μmol/L] ,and that of severe group was significantly higher than that of mild group ,P<0.05 or <0.01 ;Pearson correlation analysis indi-cated that Hcy level was positively correlated with IS severity in aged EH patients (r=0.41 ,P<0.01);during in-tervention therapy ,compared with group A , there were significant reductions in percentage of IS (26.7% vs . 6.7% ) and Hcy level [(24.36 ± 2.29)μmol/L vs .(15.71 ± 3.17)μmol/L] in group B ,P<0.5 or <0.01. Conclu-sion:Among aged EH patients ,Hcy level is significantly correlated with IS severity ,which can be used as an impor-tant severity and prognosis index for IS .%目的：探讨同型半胱氨酸（Hcy）水平与老年原发性高血压（EH ）发生缺血性脑卒中严重程度及其预后的相关性。方法：回顾性分析2011年1月至2013年1月于我院确诊的老年EH患者135例的临床资料，其中单纯高血压患者45例（EH对照组），并发缺血性脑卒中患者90例（EH＋缺血性脑卒中组），按照Rankin评分（mRS）对患者脑卒中严重程度进行评分，分为轻度组和重度组，每组各45例，分别检测三组患者的 Hcy水平，并与脑卒中严重程度进行相关性分析，之后，选择高血压患者90例进行治疗，分为A组（常规降压治疗）和B组（在常规降压基础上进行控制Hcy治疗），一年后，比较两组患者出现缺血性脑卒中的比例。结果：在治疗前，重度和轻度组的Hcy水平明显高于EH对照组[（34.55±4.56）μmol／L比（18.88±3.31）μmol／L比（15.03±2.43）μmol／L]，且重症组Hcy水平明显高于轻度组（P＜0.05或＜0.01）；Pearson相关分析显示 Hcy水平与老年EH发生缺血性脑卒中严重程度呈显著正相关（r＝0.41， P＜0.01），在干预治疗中，B组出现缺血性脑卒中的比例明显低于A组（6.7％比26.7％），且Hcy水平也明显较低[（15.71±3.17）μmol／L比（24.36±2.29）μmol／L]， P＜0.05或＜0.01。结论：在老年高血压患者中，同型半胱氨酸水平与缺血性脑卒中的严重程度显著相关，可以作为缺血性脑卒中严重程度及其预后判断的重要指标。