Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Postępy Nauk Medycznych 1/2012, s. 15-21
*Witold Palasik1, Wiesław Tadeusiak2, Urszula Fiszer1
Znaczenie kliniczne hyperhomocysteinemii u chorych z udarem niedokrwiennym mózgu
Clinical importance of hyperhomocysteinemia in patients with ischemic stroke**
1Department of Neurology and Epileptology, Medical Center of Postgraduate Education, Warsaw, Poland
Head of Department: prof. dr hab. med. Urszula Fiszer
2Department of Anesthesiology, Medical Center of Postgraduate Education, Warsaw, Poland
Head of Department: dr med. Małgorzata Malec
Streszczenie
Wstęp. Homocysteina jest aminokwasem powstającym w czasie metabolizmu metioniny do cysteiny. Podwyższony poziom homocysteiny jest niezależnym czynnikiem ryzyka dla chorób układu sercowo-naczyniowego.
Cel pracy. Celem tego badania była analiza poziomu homocysteiny w surowicy krwi pacjentów we wczesnym okresie niedokrwiennego udaru mózgu. Do klasyfikacji chorych użyto skale Oxfordshire Community Stroke Project (OCSP)
Materiał i metody. Przebadano surowicę uzyskaną od 193 chorych w ostrym okresie niedokrwiennego udaru mózgu. Całkowity poziom homocysteiny oznaczono przy pomocy immunofluorescencyjnej polaryzacji (FPIA-ABBOTT).
Wyniki. Nie stwierdzono statystycznej różnicy poziomu homocysteiny u chorych z udarem vs grupa kontrolna. Podwyższony poziom homocysteiny stwierdzono u 35,3% chorych i w porównaniu z całą grupą chorych z udarem był on najwyższy w grupie z udarem lakunarnym (LACI) (p < 0,007). Poziom homocysteiny powyżej 15 μmol/l stwierdzano u 41,9% chorych z LACI. To był najwyższy, statystycznie znamienny (p < 0,02), poziom w porównaniu z innymi badanymi grupami chorych z udarem.
Wnioski. Wyniki wskazują na istotną rolę homocysteiny jako niezależnego czynnika ryzyka dla niedokrwiennego udaru mózgu typu LACI. Nie stwierdzono natomiast, aby poziom homocysteiny był niezależnym czynnikiem ryzyka dla wystąpienia udaru niedokrwiennego mózgu.
Summary
Introduction. Homocysteine is an amino acid, produced during the metabolism of methionin to cystein. A high concentration of total homocysteine is a strong and independent risk factor for cardiovascular diseases.
Aim. The aim of the study was to analyze the homocysteine concentrations in the blood of patients in the early stage of stroke according to clinical assessment in the Oxfordshire Community Stroke Project (OCSP) classification.
Material and methods. We examined the sera of 193 patients in the early stage of stroke. Total plasma homocysteine concentrations were measured by fluorescence polarisation immunoassay (FPIA-ABBOTT).
Results. We did not find statistical difference of concentration of homocysteine between control group vs group of stroke patients. We found an increased pathological homocysteine concentration in 35.3% subjects and compared to the total number group of examined stroke patients this concentration was significantly higher in the (lacunar circulation infarct) LACI group (P < 0.007). A homocysteine concentration > 15 μmol/l was observed in 41.9% of LACI patients. This was the highest statistically significant concentration (P < 0.02) compared to the other groups of patients.
Conclusions. Our results determined the association of lacunar stroke with an increased homocysteine concentration as independent risk factor.
Introduction
An increased concentration of total homocysteine is a still disputable as a independent risk factor for cardiovascular diseases and also a predictor of cerebrovascular diseases, especially of stroke (1). There is no doubt that hyperhomocysteinemia plays an important role in the atherosclerotic and thromboembolic process and promotes them. The mechanisms of these processes are very complicated and depend on many factors like the concentration of foliate, vitamin B12 and B6. It is also important that the concentration of increased serum homocysteine correlates with the state of vascular damage. Experimental data suggest that homocysteine has an influence on the oxidative arterial injury, damaging the vascular matrix and augmenting the proliferation of vascular smooth muscle. Homocysteine also alters the coagulation properties of the blood and impairs endothelium-dependent vasomotor regulation.
The reference value of the normal homocysteine concentration is between 5-15 μmol/l and this value is widely and commonly used. In this paper we present and discuss the association between hyperhomocysteinemia and types of stroke according to the Oxfordshire Community Stroke Project (OCSP) (2).
Material and methods
Patients
We examined 193 patients (tab. 1a, 1b, 2) with acute ischemic stroke (83 men and 110 women, aged 53 to 96 years, mean 71.60 years), successively admitted to the Department of Neurology and Epileptology of the Center for Postgraduate Medical Education in Warsaw. The diagnosis of ischemic stroke was based on a history of sudden onset of a fixed neurological focal deficit of presumed ischemic origin lasting more than 24 hours. CT of the brain was performed on all patients to exclude other causes of neurological symptoms. Patients were classified into one of four stroke types according to the OCSP classification: TACI (Total anterior circulation infarction), PACI (Partial anterior circulation infarction), LACI (Lacunar infarction) and POCI (Posterior circulation infarction) (2). Group characteristics (stroke patients and controls with other neurological disease) are summarised in table 3. The local Ethics Committee of the Center for Medical Postgraduate Education in Warsaw approved this study.
Table 1a. Demographic data of group: gender and age.
Gender Group
Stroke patients Controls
FemaleN 110 19
% 57.0% 55.9%
MaleN 83 15
% 43.0% 44.1%
Chi-Square test = 0.02 P < 0.904
Table 1b. Demographic data of group: gender and age.
AgeN Mean ± (SD)
Stroke patients192 71.59 ± 10.96
Controls34 71.15 ± 11.92
Two-tailed Student’s t-test t = 0.22 P < 0.829
Table 2. The concentration of homocysteine in group patients with stroke and controls.
Concentration of homocysteineN Mean ± (SD)
Stroke patients193 14.95 ± 6.19
Controls34 13.06 ± 3.67
Manna Whitney U test z = -1.59 P < 0.113
Table 3. Demographic data of group HC1 (patients with homocysteine concentrations over 15 μmol/l) and HC2 (patients with homocysteine concentrations below 15 μmol/l).
Parameters Total HC1 > 15μmol/l (n=74) HC1 < 15μmol/l (n=119)
Gender Female
Male
110
83
38 (51.4%)
36 (48.6%)
72 (60.5%)
47 (39.5%)
Age
Mean ± SD
95% CI
Median
75%
25%
min.
max.
71.6
± 10.9
70.0-73.1
73
79
67
35
95
74.29*
8.76
72.26-76.33
75.5
81
68
45
91
69.89
11.84
67.73-72.05
72
78
63
36
95
Two-tailed Student’s t-test HC1 vs HC2 *P < 0.0001
Blood sampling and quantification of homocysteine concentration
Peripheral blood was obtained in the first 48 hours after onset of symptoms of stroke. The blood has been immediately centrifuged. Serum was stored at -20oC. Total plasma homocysteine concentrations were measured by fluorescence polarisation immunoassay (FPIA-ABBOTT) (3). We considered a homocysteine concentration > 15 μmol/l as pathological basing our findings on Ueland’s study (4). Therefore patients for analysis were divided into two groups: patients with the homocysteine concentration in sera < 15 μmol/l and the homocysteine concentration in sera > 15 μmol/l.
Statistical analysis
The statistical analyses were performed by Statistica (StatSoft, USA) version 6.0. For descriptive purposes, univariate analysis with either the chi-square test or Fisher’s exact test (depending on the sample size) was used to perform evaluation of frequency distribution proportionality for categorical variables, while one-way analysis of variance (ANOVA) was used for continuous variables. The statistical significance of differences between groups was evaluated by the non-parametric Mann-Whitney U test. Multivariate logistic regression with odds ratio (OR) was performed.
Results
We found an increased pathological homocysteine concentration in 35.3% (74 cases – 38 female and 36 male) (tab. 3). We did not find statistical significance of differences between groups of stroke patients vs controls. It was evaluated by the non-parametric Mann-Whitney U test (tab. 2). Therefore we divided stroke patients group into two subgroups: patients with stroke and normal concentration of homocysteine and patients with stroke and with increased over 15 μmol/l (according to the FPIA-ABBOTT recommendation we take the concentration of homocysteine lower than 15 μmol/l as a normal). The presence of the highest concentrations was most frequently observed among patients with LACI (fig. 1). Compared to the total number group of examined stroke patients this concentration was significantly higher in the LACI group (P < 0.007) (fig. 3). Additionally, a homocysteine concentration > 15 μmol/l was observed in 41.9% of LACI patients. This was the highest statistically significant concentration (P < 0.02) compared to the other groups of patients (fig. 2). In the group of patients with PACI an increased homocysteine concentrations was found in 35.1% of subjects, while concentrations of 14.9% and 8.1% were found in TACI and POCI patients respectively (fig. 3).
Fig. 1 Analysis of homocysteine concentrations vs. type of stroke according to the Oxfordshire Community Stroke Project (OCSP): TACI (Total anterior circulation infarction), PACI (Partial anterior circulation infarction), LACI (Lacunar infarction), POCI (Posterior circulation infarction).
Fig. 2. Analysis of homocysteine concentrations – lacunar stroke vs. other types of stroke according to the Oxfordshire Community Stroke Project (OCSP): TACI (Total anterior circulation infarction), PACI (Partial anterior circulation infarction), LACI (Lacunar infarction), POCI (Posterior circulation infarction).
Fig. 3. Percentages of patients in groups vs. type of stroke according to the Oxfordshire Community Stroke Project (OCSP): TACI (Total anterior circulation infarction), PACI (Partial anterior circulation infarction), LACI (Lacunar infarction), POCI (Posterior circulation infarction) and homocysteine concentration – HC1 (patients with homocysteine concentration over 15 μmol/l) and HC2 (patients with homocysteine concentrations below 15 μmol/l).

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otrzymano: 2011-11-24
zaakceptowano do druku: 2011-12-14

Adres do korespondencji:
*Witold Palasik
Klinika Neurologii i Epileptologii CMKP
ul. Czerniakowska 231, 00-416 Warszawa
tel.: (22) 629-43-49
e-mail: witpal3@wp.pl

Postępy Nauk Medycznych 1/2012
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