Correlation Between Plasma Homocysteine Levels And Atherosclerotic Quasi-moyamoya Disease

Background and Objective Moyamoya disease is characterized by progressive stenosis and occlusions of distal internal carotid arteries(ICAs)and their major branches.The vascular stenosis or occlusion is accompanied by the growth of small collateral vessels in the bottom of cerebrum.Vascular lesions involving both sides and the congenital cause are essential for the diagnosis of MMD.Quasi-moyamoya Disease is a secondary moyamoya disease.its characteristic vascular lesions can be involved in unilateral or bilateral,accompanying with underlying diseases,also known as moyamoya syndrome.Quasi-moyamoya Disease accompanied with atherosclerosis is also known as atherosclerotic quasi-moyamoya disease.The outstanding advances have been made in clinical and experimental researchs on MMD,while few studies focusing on quasi-moyamoya disease currently.The existing studies on quasi-moyamoya disease are also related to its epidemiological characteristics,and little is known about the pathogenesis.Thus,researchs on the pathogenesis of atherosclerotic quasi-moyamoya disease is less.It remains inconclusive whether the association between atherosclerosis and moyamoya vasculopathy(MMV)is because of the early development of atherosclerosis or the late detection or development of MMV.Hcy is an amino acid that damages vessels,with a variety of biological effects, and HHcy has been confirmed to be a risk factor for atherosclerosis.There was a case report indicating that HHcy is associated with the occurrence of quasi-moyamoya disease in the early years,but the subsequent similar studies are few and mostly are case reports.In this study,we aim to investigate the relationship between plasma Hcy level and atherosclerotic quasi-moyamoya disease by analyzing the levels of plasma Hcy in patients with atherosclerotic quasi-moyamoya and atherosclerotic cerebral infarction and healthy controls,and thus provide a reference for the prevention and treatment of the disease.Methods 95 ischemic stroke patients with atherosclerotic quasi-moyamoya disease(quasi-moyamoya disease group),95 patients with atherosclerotic cerebral infarction(stroke group)were recruited in our study.94 healthy volunteers were recruited as healthy control(control group).The plasma Hcy levels were detected.The demographic characteristics,vascular risk factors,and laboratory data were collected.The correlation between the plasma Hcy level and atherosclerotic quasi-moyamoya disease was analyzed.According to the method of moyamoya diasease staging proposed by Japanese scholar Mugikura,the degree of vascular lesions of quasi-moyamoya patientes were staged.The relativity between the plasma Hcy levels and the degree of vascular lesions were analyzed by Spearman correlation analysis.Results 1.There were significant differences in the proportions of patients with hypertension,hyperlipidemia,previous stroke or transient ischemic attack(TIA),hyperhomocysteinemia(HHcy),as well as systolic blood pressure,total cholesterol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),Hcy,vitamin B12,folate level between the quasi-moyamoya group and the control group(all p<0.05/3).2.There were significant differences in the proportions of patients with previous stroke or TIA,as well as systolic blood pressure,and folate level between the quasi-moyamoya group and the stroke group(all p<0.05/3).3.Compared with the control group,multivariate logistic regression analysis showed that Hcy(odds ratio,[OR] 1.806,95% confidence interval,[CI] 1.348?2.420;P=0.000),previous stroke or TIA,(OR 3.519,95%CI 1.709?7.028;P=0.013),systolic blood pressure(OR 1.099,95%CI 1.035?1.168;P=0.002),and LDL-C(OR 38.473,95%CI 6.384?231.842;P=0.000)were the risk factors for atherosclerotic quasi-moyamoya disease,while HDL-C(OR 0.025,95%CI 0.001?0.768;P=0.035)and folate(OR 0.779,95%CI 0.608?0.996;P=0.047)were its protective factors.4.Compared with the stroke group,multivariate logistic regression analysis showed that previous stroke or TIA(OR 3.280,95%CI 1.664?6.466;P=0.001)and systolic blood pressure(OR 1.019,95%CI 1.002?1.035;P=0.029)were the risk factors for quami-moyamoya disease,while folate(OR 0.845,95%CI 0.750?0.952;P =0.006)was its protective factor.5.Spearman correlation analysis shows that the plasma Hcy level in quasimoyamoya disease group was positively correlated with the stage of moyamoya diaseae(r=0.467;P<0.01).Conclusion 1.The elevated Hcy level is a risk factor for atherosclerotic quasi-moyamoya disease.It plays an important role in its pathogenesis.2.The plasma level of Hcy is positively correlated with the severity of vascular lesions in quasi-moyamoya disease group.