【摘要】：目的：觀察房顫、單純腦卒中、房顫合并腦卒中患者血清中的同型半胱氨酸（HCY）的水平及評估高同型半胱氨酸（Hhcy）是否為非瓣膜房顫合并腦卒中的獨(dú)立預(yù)測因子。 方法：選取非瓣膜房顫患者50例，單純腦卒中患者50例，非瓣膜房顫合并腦卒中患者48例，，正常對照人群50例。分別采空腹靜脈血液3ml,同型半胱氨酸采用美國AU5400循環(huán)酶法測定，D-D聚體采用透射免疫比濁法測定。比較四組同型半胱氨酸水平有無顯著性差異。 結(jié)果：1、與正常組比較，房顫組HCY水平升高(16.26±0.72μmol/L vs9.94±4.24μmol/L，P0.05)；單純腦卒中組HCY水平升高(21.86±0.93μmol/L vs9.94±4.24μmol/L，P0.05)；房顫合并腦卒中組HCY水平升高(23.41±3.37μmol/Lvs9.94±4.24μmol/L，P0.05)。房顫合并腦卒中組HCY水平明顯高于房顫組(23.41±3.37μmol/Lvs16.26±0.72μmol/L，P0.05)；房顫合并腦卒中組HCY水平較單純腦卒中組升高，但無統(tǒng)計學(xué)差異（23.41±3.37μmol/Lvs21.86±0.93μmol/L，P0.05）。2、HCY17μmol/L為陽性標(biāo)準(zhǔn)，房顫合并腦卒中組與房顫組的陽性檢出率比較有統(tǒng)計學(xué)差異（P0.05），HCY明顯升高的房顫患者發(fā)生腦卒中的危險是HCY不升高房顫患者的4.12倍。3、房顫組與房顫合并腦卒中組比較：65歲以上的老年人在房顫合并腦卒中組占97.67%，高于房顫組52%，P0.05；房顫合并卒中組伴發(fā)高血壓72.92%，而房顫組僅為46%，P0.05；房顫合并腦卒中組伴糖尿病者占25%，而房顫組僅占8%，P0.05；房顫合并腦卒中組伴高脂血癥者占72.92%，房顫組占48%，P0.05。提示房顫合并腦卒中組在年齡≥65歲，伴發(fā)高血壓、糖尿病、高脂血癥方面的發(fā)生率均高于房顫組。4、Logistic回歸結(jié)果顯示：高同型半胱氨酸（OR=1.696，P0.05）、高齡(OR=1.607,P0.05)是非瓣膜房顫合并腦卒中的獨(dú)立危險因素。5、Spearman相關(guān)性分析示：同型半胱氨酸與D-D聚體無相關(guān)性。 結(jié)論：1、血清同型半胱氨酸升高易致腦卒中。 2、血清同型半胱氨酸在非瓣膜心房顫動及非瓣膜房顫合并腦卒患者中升高。 3、同型半胱氨酸明顯升高的房顫患者比同型半胱氨酸不升高的房顫患者更易發(fā)生腦卒中。 4、年齡≥65歲，高血壓、糖尿病、高脂血癥是房顫合并腦卒中的危險因素。
[Abstract]:Aim: to observe the level of homocysteine (HCY) in serum of patients with atrial fibrillation, simple stroke and atrial fibrillation with stroke and to evaluate whether high homocysteine (Hhcy) is an independent predictor of non-valvular atrial fibrillation with stroke. Methods: fifty patients with non-valvular atrial fibrillation, 50 patients with simple stroke, 48 patients with non-valvular atrial fibrillation complicated with stroke and 50 normal controls were selected. Fasting venous blood samples were collected. Homocysteine was determined by AU5400 circulatory enzyme method and D-D polymer by transmission immunoturbidimetry. To compare the difference of homocysteine level among the four groups. Results: 1, compared with the normal group, the level of HCY in AF group was increased (16.26 鹵0.72 渭 mol/L vs9.94 鹵4.24 渭 mol/L,P0.05), the HCY level in stroke group was increased (21.86 鹵0.93 渭 mol/L vs9.94 鹵4.24 渭 mol/L,P0.05). The level of HCY in patients with atrial fibrillation and stroke was increased (23.41 鹵3.37 渭 mol/Lvs9.94 鹵4.24 渭 mol/L,P0.05). The level of HCY in AF with stroke group was significantly higher than that in AF group (23.41 鹵3.37 渭 mol/Lvs16.26 鹵0.72 渭 mol/L,P0.05). The level of HCY in atrial fibrillation with stroke group was higher than that in simple stroke group, but there was no statistical difference (23.41 鹵3.37 渭 mol/Lvs21.86 鹵0.93 渭 mol/L,P0.05) .2HCY17 渭 mol/L was the positive standard. There was significant difference in the positive detection rate between the patients with atrial fibrillation complicated with stroke and those with atrial fibrillation (P0.05). The risk of cerebral apoplexy in patients with atrial fibrillation (), HCY) was 4.12 times higher than that in patients with atrial fibrillation (HCY) was 4.12 times higher than that in patients with atrial fibrillation. Comparison between atrial fibrillation group and atrial fibrillation with stroke group: the elderly over 65 years old accounted for 97.67% of atrial fibrillation with stroke group, which was higher than 52% of atrial fibrillation group (P 0.05). In the AF with stroke group, the incidence of hypertension was 72.92%, while that in the AF group was only 46% (P0.05), and that in the AF with stroke group was 25%, while that in the AF with stroke group was only 8% (P0.05). The incidence of hyperlipidemia was 72.92 in atrial fibrillation with stroke group and 48 in atrial fibrillation group (P 0.05). The results suggest that the incidence of hypertension, diabetes and hyperlipidemia in patients with atrial fibrillation and stroke is higher than that in patients with atrial fibrillation and stroke. 4 the results of logistic regression showed that the incidence of hyperhomocysteine (OR=1.696,P0.05) was higher than that in patients with atrial fibrillation. Age (OR=1.607,P0.05) is an independent risk factor for non-valvular atrial fibrillation associated with stroke. 5Spearman correlation analysis showed that homocysteine was not associated with D-D polymer. Conclusion: 1. The increase of serum homocysteine may lead to stroke. 2. Serum homocysteine was elevated in patients with non-valvular atrial fibrillation and non-valvular atrial fibrillation with stroke. 3. Patients with atrial fibrillation with significantly increased homocysteine were more likely to have stroke than those with atrial fibrillation with no increase in homocysteine. 4, age 鈮

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