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目的：检测不同类型脑卒中患者血清中同型半胱氨酸(Hcy)浓度，探究其临床意义。方法：将2011 年2 月至2014 年10 月期间入我院接受治疗的140 例脑卒中患者纳入本次研究，作为研究组，其中包含64 例脑梗死患者（CI组）、42 例脑出血患者（CH 组）以及34 例短暂性脑缺血发作患者（TIA 组），同时以同期135 例体检健康者作为对照组。采用循环酶法测定所有研究对象血清 Hcy水平，同时采用放射免疫法对其血清内维生素B12、叶酸浓度进行测定。结果：研究组血清Hcy浓度高于对照组，组间差异显著(P<0.05)；研究组的叶酸及VitB12 低于对照组，组间差异均有统计学意义(P<0.05)；两组年龄、TC、TG、LDL-C 等指标在组间存在差异(P<0.05)，两组HDL-C 差异无统计学意义(P>0.05)。CI组、CH组、TIA 组血清Hcy水平均高于对照组，差异均有统计学意义 (P<0.05)，但在CI组、CH组、TIA 组三组相互对比中，组间差异无统计学意义(P>0.05)。进展性脑梗死组血清内Hcy浓度高于完全性脑梗死组，组间数据具有显著差异(P<0.05)。不同NIHSS 评分患者血清内Hcy浓度不同，评分越高，Hcy浓度越高，两者呈显著正相关关系(P<0.05)。回归性相关分析，脑卒中发病危险因素为高Hcy、高总胆固醇、高LDL-C、低叶酸、低VitB12 (P<0.05)。结论：脑卒中患者与健康人群血清Hcy 水平存在差异，不同类型脑卒中血清Hcy水平存在差异，且血清中同型半胱氨酸水平与脑卒中发病存在相关性，因此可以将血清Hcy作为脑卒中预测、诊断及预后判断的重要指标之一。

英文摘要:

Objective:To explore clinical significance of detecting serum levels of homocysteine in different types of stroke patients.Methods:A total of 140 stroke patients, who were admitted to Shanghai Post and Telecommunication Hospital from February 2011 to October 2014, were selected as research group, including 64 cases of cerebral infarction (CI group) and 42 cases of cerebral hemorrhage (CH group) and 34 cases of transient ischemic attack (TIA group); at the same time, 135 healthy subjects in the physical examinations, as control group. The levels of serum Hcy in the research and control groups were detected by Recycling enzymatic determination, and serum vitamin B12 level and folic acid concentration were measured by radiation immune.Results:The serum Hcy concentration in the research group (including CI group,CH group and TIA group) was higher than that in the control group,with significant difference between the groups (P<0.05); folic acid and VitB12 in the research group was lower than that in the control group, differences between the groups were statistically significant (P<0.05); the differences of age, TC, TG, LDL-C between the two groups were statistically significant (P<0.05), the difference of HDL-C between the two groups was not statistically significant (P>0.05). The serum Hcy concentration in the progressive cerebral infarction group was higher than that in the complete cerebral infarction group, with significant difference (P<0.05). The serumHcy concentration in patients with different NIHSS scores was different, the higher the score, the higher the Hcy concentration, both were significantly positive correlation (P<0.05). According to regression correlation analysis, the risk factors of onset of stroke were high Hcy, high total cholesterol, high LDL-C, lower folic acid and lower VitB12 (P<0.05).Conclusion:There are differences in the levels of serum Hcy between cerebral apoplexy patients and healthy people, levels of serum Hcy in different types of cerebral apoplexy vary, and levels of serum Hcy is associated with the onset of cerebral apoplexy, so serum Hcy can be used as one of important indexes of prediction, diagnosis and prognosis of patients with cerebral apoplexy.

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