摘要：

目的 探讨颈动脉狭窄患者血清同型半胱氨酸水平和颈动脉内-中膜厚度以及二者的相关性。方法 选择 2012 年 1 月至 2018 年 4 月共 126 例颈动脉狭窄并行颈动脉内膜切除术的患者，根据颈动脉超声和全脑血管造影判断颈动脉狭窄程度，并测定血清同型半胱氨酸水平。结果 颈动脉狭窄组患者血清同型半胱氨酸水平［（16.47 ± 6.53）μmol/L 对（10.53 ± 3.39）μmol/L；t = 8.828，P = 0.000］、高同型半胱氨酸血症比例［61 例（48.41%）对 6 例（6%）；χ² = 48.084，P = 0.000］和颈动脉内-中膜厚度［（1.33 ± 0.15）mm 对（0.82 ± 0.11）mm；t = 28.462，P = 0.000］均高于对照组。根据颈动脉狭窄程度进一步分为颈动脉中度狭窄亚组（10 例）和重度狭窄亚组（116 例），颈动脉中度狭窄亚组患者血清同型半胱氨酸水平低于重度狭窄亚组［（13.44 ± 2.83）μmol/L 对（16.73 ± 6.69）μmol/L；t = -3.022，P = 0.007］，而高同型半胱氨酸血症比例亚组间差异无统计学意义［2 例（2/10）对 59 例（50.86%）；校正χ² = 2.384，P = 0.123］。Pearson 相关分析显示，血清同型半胱氨酸水平与颈动脉内-中膜厚度呈正相关（r = 0.610，P = 0.032）。结论 颈动脉狭窄患者血清同型半胱氨酸水平升高，且与颈动脉内-中膜厚度呈正相关。

关键词: 颈动脉狭窄, 动脉粥样硬化, 半胱氨酸

Abstract:

Objective  To investigate the serum homocysteine (Hcy) level and intima-media thickness (IMT) of patients with carotid artery stenosis and the relation between the two.  Methods  A total of 126 patients diagnosed as carotid artery stenosis and performed by carotid endarterectomy (CEA) from January 2012 to April 2018 were selected in this study. The extent of carotid artery stenosis was evaluated by carotid Doppler color ultrasound and digital subtraction angiography (DSA). Serum Hcy levels were measured in all patients and 100 healthy controls. Results The average concentration of serum Hcy [(16.47 ± 6.53) μ mol/L vs. (10.53 ± 3.39) μ mol/L; t = 8.828, P = 0.000], the incidence rate of hyperhomocysteinemia [61 cases (48.41%) vs. 6 cases (6%); χ² = 48.084, P = 0.000] and IMT of carotid artery [(1.33 ± 0.15) mm vs. (0.82 ± 0.11) mm; t = 28.462, P = 0.000] in carotid artery stenosis group were significantly higher than those in control group. According to the extent of carotid artery stenosis, the carotid artery stenosis group was further divided into moderate (N = 10) and severe (N = 116) carotid artery stenosis subgroups. The average concentration of serum Hcy in moderate stenosis group was significantly lower than that in severe stenosis group [(13.44 ± 2.83) μmol/L vs. (16.73 ± 6.69) μmol/L; t = -3.022, P = 0.007]. Nevertheless, the incidence rate of hyperhomocysteinemia [2 cases (2/10) vs. 59 cases (50.86%); adjusted χ² = 2.384, P = 0.123] had no significant difference between 2 subgroups. Pearson correlation analysis demonstrated that the concentration of serum Hcy was positively related with IMT of carotid artery (r = 0.610, P = 0.032). Conclusions Patients with carotid artery stenosis present higher level of serum Hcy, which is positively associated with IMT.

Key words: Carotid stenosis, Atherosclerosis, Cysteine