目的 利用高分辨率磁共振成像(HR-MRI)评估不同血浆同型半胱氨酸(Hcy)水平对脑缺血患者颅内动脉斑块易损特征的影响。方法 选择因急性脑梗死或短暂性脑缺血发作而入院的患者216例，其中男性164例，女性52例;年龄18～80岁，平均年龄57。28岁;吸烟史98例，饮酒史55例;高血压153例，糖尿病67例，冠心病19例，高脂血症62例。根据血浆Hcy水平分为正常、轻度升高、中重度升高3组。用HR-MRI评估颅内斑块易损特征。二元逻辑回归或多重线性回归用以分析血浆Hcy水平与颅内斑块强强化、斑块内出血及管腔狭窄的相关性。结果 216例症状性颅内动脉粥样硬化狭窄患者，其中血浆Hcy正常95例，血浆Hcy轻度升高86例，血浆Hcy中重度升高35例。3组间斑块强强化、斑块内出血的患病率和狭窄程度呈增加趋势[斑块强强化:42。1％(40/95)vs 67。4％(58/86)vs 71。4％(25/35);斑块内出血:6。3％(6/95)vs 7。0％(6/86)vs 20。0％(7/35);管腔狭窄率:62。88％ vs 68。05％ vs 76。10％。P＜0。05]。调整临床变量(包括年龄、性别、饮酒、吸烟、冠心病、糖尿病、高血压、高脂血症)后，与血浆Hcy正常组相比，血浆Hcy中重度升高是颅内斑块强强化[比值比(OR)=3。647，95％可信区间(CI)1。491～8。926，P=0。005]及斑块内出血(OR=4。298，95％CI 1。155～15。994，P=0。030)的独立预测因子。血浆Hcy轻度升高也与斑块强强化(OR=3。188，95％CI 1。676～6。066，P＜0。001)独立相关。多重线性回归模型显示血浆Hcy升高与管腔狭窄率(B=0。320，β=0。192，P=0。006)呈正相关。结论 血浆Hcy不同程度升高可能作为颅内动脉粥样硬化斑块易损性的潜在诊断生物标志物。Hcy中重度升高可能导致斑块易损程度进一步恶化，应在临床管理中更积极的干预。
Effect of plasma homocysteine level on characteristics of intracranial atherosclerotic plaques in cerebral ischemia e-valuation by HR-MRI
Objective To evaluate the effects of different plasma homocysteine(Hcy)levels on vulnerability of intracranial ar-terial plaques in patients with cerebral ischemia by high-resolution magnetic resonance imaging(HR-MRI).Methods A total of 216 patients with acute cerebral infarction or transient ischemic attack were enrolled,which included 164 males and 52 fe-males,aged 18-80 years old with mean age of 57.28 years old;98 cases of smoking history and 55 of drinking history.There were 153 cases of hypertension,67 of diabetes,19 of coronary heart disease and 62 of hyperlipidemia.According to plasma Hcy level,all of them were divided into normal group,mild elevated group and moderately severe elevated group.HR-MRI was used to evaluate vulnerability of intracranial plaques.The binary Logistic regression or multiple linear regression was used to analyze the correlation between plasma Hcy level and strong enhancement of intracranial plaques,intraplaque hemorrhage and lumen stenosis.Results Among the 216 enrolled patients,there were 95 cases with normal Hcy(normal group),86 mild ele-vated Hcy(mild elevated group)and 35 moderately severe elevated Hcy(moderately severe elevated group).The prevalence of strong plaque enhancement,intraplaque hemorrhage and stenosis degree showed increased trend in 3 groups[strong plaque en-hancement:42.1％(40/95)vs 67.4％(58/86)vs 71.4％(25/35);intraplaque hemorrhage:6.3％(6/95)vs 7.0％(6/86)vs 20.0％(7/35);lumen stenosis rate:62.88％ vs 68.05％ vs 76.10％.P＜0.05].After adjustment of clinical variables(age,gender,alcohol consumption,smoking,coronary heart disease,diabetes,hypertension,hyperlipidemia),moderate-severe elevated Hcy was an independent predictor of intracranial plaque enhancement[odds ratio(OR)=3.647,95％confidence interval(CI)1.491-8.926,P=0.005]and intraplaque hemorrhage(OR=4.298,95％ CI 1.155-15.994,P=0.030)when compared with Hcy normal group.The mild elevated Hcy was also independently correlated with strong plaque enhancement(OR=3.188,95％ CI 1.676-6.066.P＜0.001).The multiple linear regression model showed that plasma Hcy elevated was positively correlated with lumen steno-sis rate(B=0.320,β=0.192,P=0.006).Conclusion It is demonstrated that the elevation of plasma Hcy in different de-grees could be used as potential diagnostic biomarker for vulnerability of intracranial atherosclerotic plaques.The moderately se-vere elevated Hcy could lead to further deterioration of plaque vulnerability,which should be more actively intervened in clinical management.
homocysteineintracranial atherosclerosishigh resolution magnetic resonance vessel wall imagingvulnerable plaque
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