Relationship Between Plasma Homocysteine Levels And Cerebral Infarction

Objective: The objective of this study was to assess the association between thelevels of homocysteine (Hcy) and acute cerebral infarction. The levels ofhomocysteine (Hcy) in patients with acute cerebral infarction and healthy controlswere measured. Those patients with high Hcy levels were treated with folic acid andvitamin B12for6months. Before and after the treatment, the Hcy levels andneurological function were assessed.Methods: From May1,2009to Oct31,2013, a total of300patients (196males and104females) with a clinical diagnosis of acute ischemic stroke from the NeurologyDepartment in the eighth people’s hospital of Shanghai were recruited in this study.Acute ischemic stroke was confirmed by imaging (CT scan or MRI) according to theacute ischemic stroke diagnosis and treatment guidelines in China. The mean age ofthe participants was57.5±8.6years. And100age and sex-matched controls wereenrolled. There was no statistical difference between observation group and controlgroup in age, sex, smoking, drinking history, hypertension, diabetes and heartdisease. Fasting blood samples were obtained from all the patients and control groupfor the analysis of the plasma Hcy, folic acid and vitamin B12, and the intima-mediathickness (IMT) were measured using carotid color duplex ultrasonography. Forthose patients with high Hcy levels were randomly divided into the interventiongroup and control group. All the two groups of patients receiving the standardizedtreatment, additional treatment including folic acid and vitamin B12in theintervention group for6months, the level of plasma Hcy, Barthel index（BI）, mRS（Modified rankin scale）and NIHSS (National institute of health stroke scale) werereassessed after the treatment.Results:1. The plasma Hcy levels in patients with cerebral infarction group weresignificantly higher than those of control group (p<0.05).2. Plasma Hcy levels in patients with cerebral infarction group were positivelycorrelated with IMT (r=00.845, p=00.845). 3. Plasma Hcy levels in patients with cerebral infarction group werenegatively correlated with folic acid and VitB12levels(r=0.495, r=0.495, p <0.05).4. Higher Hcy levels were found in patients with types1and2subtypesaccording to TOAST Criteria.5. There was an apparent decrease in the levels of plasma Hcy before and aftertreatment with folic acid and VitB12for6months.(p<0.05).6. Compared to control group, the NIHSS score was significantly decreased inthe treatment group (those patients were treated with folic acid and VitB12for6months)（p＜0.05）, but no significant difference was observed between the twogroups regarding the improvements in the BI and mRS scores at the end of thetreatment.(P>0.05).Conclusion:1. The plasma Hcy levels in patients with acute cerebral infarction were higherthan those in control group, suggesting that there might be a close relationshipbetween the occurrence of cerebral infarction and high plasma Hcy level.2. Plasma Hcy levels were positively correlated with IMT, which suggestedthat elevated plasma Hcy levels were associated with carotid atherosclerosis.3. Higher Hcy levels were found in patients with types1and2subtypesaccording to TOAST Criteria..4. Supplementation with folic acid and VitB12could effectively decrease theplasma Hcy levels in patients with higher blood plasma Hcy levels.5. Decreased NIHSS scores were found in patients treated with folic acid andVitB12，indicating that the treatment with folic acid and VitB12improved the patients’neurological conditions.