| Objective: Cerebral stroke, the second cause of death in our country, seriously affects the health and living of people. Its high incidence, disability, mortality and recurrence rate give a heavy burden on the family, society and country. Eighty percent of cerebrovescular disease is cerebral infarction. In recent years, the onset age of cerebral infarction is becoming younger, and the clinical characteristics is different from that caused by the traditional risk factors,such as hypertention, diabetes, cardiac disease, hyperlipoidemia, smoking, alcohol abuse,and so on. It has been generally accepted that hyperhomocysteinemia is a preventable and medicable risk factor of cerebrovescular disease. So it is very important and significant to study the characteristics of cerebral infarction caused by hyperhomocysteinemia for the early prevention and treatment.Materials and methods: In our study, there were 90 cases (age, 26-76 years; mean age, 47.67±12.34 years) with cerebral infarction, who were hospitalized in our neuro-department and tested blood plasma homocysteine for the hospital duration. All patients were diagnosed by clinical standards referred to the fourth national cerebrovascular diseases meeting in 1995 and confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI). The ratio of male to female was 3.1:1. Malignant tumor, liver and renal disease, hypothyrosis, pernicious anemia, drugs (eg. antiepileptic, folic acid) were exclusion criteria. These participants were divided into two groups. The case group contained 60 cases (age, 26-76 years; mean age, 47.3±13.08 years; male to female, 6.5:1; male, 86.67 percent), the levels of plasma homocysteine of which were higher than the normal level (15μmol/L). The other 30 cases were the control group (age, 28-69 years; mean age, 48.4±10.67 years; male to female, 1.14:1; male, 53.33 percent), whose levels of plasma homocysteine were normal (<15μmol/L). We collected the general data (gender, age, history of other diseases, premorbid TIA, smoking, alcohol abuse), the severity of neurological deficit (assessed by the nation institutes of health stroke scale, NIHSS), biochemical parameter (blood-lipoids, fibrinogen), plasma homocysteine, progressing for the hospital duration or not, recurrent or not and neuroimaging feature. All data were analyzed by SPSS13.0. The measurement data were analyzed by Two-sample t-test for independent samples and nonparameter test. The numeration data were analyzed by chi-square test. Spearman correlation was used to analyze the correlation between Hcy and other risk factors.Results:1 General parameters: Univariate analysis showed, in the case group, 52 cases (86.67%) were male, 28 cases (46.67%) had smoking history, 17 cases (28.33%) had alcohol abusing history, the levels of plasma Hcy were 28.84±13.19μmol/L, low density lipoprotein- cholesterol (LDL-C) were 2.98±0.63mmol/L; In the control group, 16 cases (53.33%) were male, 7 cases (23.33%) had smoking history, 1 cases (3.33%) had alcohol abusing history, the levels of plasma Hcy were 10.90±2.79μmol/L, LDL-C were 2.69±0.67mmol/L. There was statistical difference in the above parameters between two groups (p<0.05). While there was no significant difference in age, history of other disease (hypertention, diabetes, cardiac disease), TIA before this stroke, total cholesterol (CHOL), triacylglycerols (TG), high density lipoprotein-cholesterol (HDL-C) and fibrinogen (FIB) between case group and control group.2 The correlation analysis of blood plasma Hcy and other risk factors: The result shows that the plasma Hcy is significantly correlative to gender (r=0.257, p=0.015), not to age, history of other diseases, TIA, smoking, alcohol abusing, blood-lipoid and fibrinogen.3 Clinical characteristics3.1 The severity of neurological deficit and plasma Hcy: In the case group, 25 cases (41.67%) were mild neurological deficit (NIHSS<4), 33 cases (55%) were moderate neurological deficit (4≤NIHSS≤15), 2 cases (3.33%) were severe neurological deficit (HIHSS>15); In the control group, 14 cases (46.67%) were mild neurological deficit , 16 cases (53.33%) were moderate neurological deficit,there were no severe neurological deficit. There was no statistical difference between the two groups in the severity of neurological deficit (p>0.05). And in the case group, the plasma Hcy of the mild, moderate, severe subsets had no statistical differences in the three subsets (p>0.05).3.2 The progressing of stroke and plasma Hcy: In the case group, there were 17 cases aggravated (28.33%), while 1case (3.33%) aggravated in the control group. There was no statistical difference between the two groups (p>0.05).3.3 Recurrent or initial infarction: In the case group, 45 cases (75%) suffered initial cerebral infarction, 15 cases (25%) were recurrent, and there were 28 (96.67%) and 2 (3.33%) separately in the control group. There was significant difference between the two groups (p<0.05).4 Neuroimaging feature4.1 Infarct size: In the case group, 17 cases (28.33%) were small area infarct(the diameter of the largest infarct layer≤1.5cm), 21 cases (35%) were moderate area infarct (1.5cm0.05). Comparing the large area infarct with the non-large area infarct between the case group and the control group, p=0.051, it was not definite whether there was statistical difference or not. And comparing the plasma Hcy of different infarct size in the case group, there was no difference in the three subsets (p>0.05).4.2 Multi-infarct lesion or mono-infarct lesion: 16 cases (26.67%) were mono-infarct lesion, and 44 cases (73.33%) were multi-infarct lesion in the case group, while, in the control group, there were 18 cases (60%) and 12 cases (40%) separately. There was difference between the two groups (p<0.05).4.3 Lesion location: In the case group, there were 35 cases (58.33%) with anterior circulation infarcts, 7 cases (11.67%) with posterior circulation infarcts and 18 cases (30%) with both of the infarcts; In the control group, there were 15 cases (50%),6 cases (20%) and 9 cases (30%) separately. There was no difference in statistics (p>0.05).Conclusions:1 Cerebral infarction caused by hyperhomocysteinemia is common in men and mostly aggravated at the acute phase. Its risk of recurrence is higher, and its neuroimaging feature is characterized by multi-infarct lesion.2 Elevated plasma homocysteine levels have no effect on the neurological deficit, lesion location and infarct size.3 Early detection of plasma homocysteine is very important for the control of progressing of cerebral infarction and the prevention of recurrence. |
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