Lindgren A, Brattström L, Norrving B, Hultberg B, Andersson A, Johansson B B
Department of Neurology, University Hospital, Lund, Sweden.
Stroke. 1995 May;26(5):795-800. doi: 10.1161/01.str.26.5.795.
Stroke patients frequently manifest moderate hyperhomocysteinemia. In most published studies, plasma homocysteine was measured at least 1 month after stroke (or the interval was not reported). To determine whether plasma homocysteine concentrations change in the acute phase, we compared acute-phase values with both convalescent-phase and control values.
Plasma homocysteine concentrations were measured in the acute phase (mean, 2 days after stroke onset) in 162 first-ever stroke patients aged 50 years or more (median, 75 years) and again at a median interval of 583 days (range, 460 to 645 days) after stroke onset in a subgroup of 17 patients, with values for 60 age-matched subjects serving as controls. Twenty of the control subjects were reexamined 2 to 3 years after their initial examination.
The median plasma homocysteine concentration was 13.4 mumol/L in the patient group compared with 13.8 mumol/L for control subjects (NS, Mann-Whitney U test) and increased from 11.4 mumol/L in the acute phase to 14.5 mumol/L in the convalescent phase in the subgroup of patients examined twice (P < .01, Wilcoxon signed rank test). In the 20 reexamined control subjects, no significant change over time in plasma homocysteine concentration was found.
The post-acute-phase increase in plasma homocysteine may explain why higher values were obtained for stroke patients than for control subjects in previous studies. Possible reasons for the variation in plasma homocysteine concentrations over time are (1) an acute-phase reduction secondary to a decrease in plasma albumin and (2) an increase in plasma homocysteine during the convalescent phase due to modified vitamin intake and/or lifestyle. The timing of plasma homocysteine measurements relative to stroke onset is a factor to be considered in the interpretation of results.
中风患者常表现为中度高同型半胱氨酸血症。在大多数已发表的研究中，血浆同型半胱氨酸是在中风后至少1个月测量的（或未报告间隔时间）。为了确定急性期血浆同型半胱氨酸浓度是否会发生变化，我们将急性期值与恢复期值及对照值进行了比较。
对162例年龄50岁及以上（中位数75岁）的首次中风患者在急性期（平均中风发作后2天）测量血浆同型半胱氨酸浓度，并在中风发作后的中位数间隔583天（范围460至645天）对17例患者的亚组再次进行测量，以60例年龄匹配的受试者的值作为对照。20名对照受试者在首次检查后2至3年进行了复查。
患者组血浆同型半胱氨酸浓度中位数为13.4μmol/L，对照受试者为13.8μmol/L（无显著性差异，Mann-Whitney U检验），在接受两次检查的患者亚组中，血浆同型半胱氨酸浓度从急性期的11.4μmol/L升至恢复期的14.5μmol/L（P<0.01，Wilcoxon符号秩检验）。在20名复查的对照受试者中，未发现血浆同型半胱氨酸浓度随时间有显著变化。
急性期后血浆同型半胱氨酸升高可能解释了为何在先前研究中中风患者的值高于对照受试者。血浆同型半胱氨酸浓度随时间变化的可能原因是：（1）由于血浆白蛋白减少导致急性期降低；（2）恢复期由于维生素摄入和/或生活方式改变导致血浆同型半胱氨酸升高。相对于中风发作的血浆同型半胱氨酸测量时间是结果解释中需考虑的一个因素。
