The Change Of Plasma Homocysteine Concentration And The Impact On The Platelet Aggregation In Patients With Cerebral Infarction

Objective:(1)To explore the change of plasma homocysteine concentration and the impact on the platelet aggregation in patients with cerebral infarction.(2)To investigate the risk factors of cerebral infarction.Methods:(1)131 patients with CT or MRI-confirmed cerebral infarction and 21 controls.Total plasma homocysteine was determined by fluorescence polarization immunoassay,platelets aggregation was measured by turbidimetric method.(2)Simultaneously,objects detailed history and clinical findings were obtained. Investigations like hypertension,alcoholintake,smoking,diabetesmellitus,hyperlipidemia, obesity,hyperlipidemia,family history of stroke,history of cardiac diseases,past history of transient ischaemic attack,complete haemogram,fasting blood glucose,urea,creatinine,lipid profile,serum Lp(a),fibrinogen,ECG,MRI/CT where indicated,were done to identify the risk factors as well.Results:(1)Total plasma homocysteine levels were significantly higher in cases than controls (median,26.90 versus 9.58μmol/L;P＜0.05).Moderate(15～30μmol/L)and intermediate(30～100μmol/L)hyperhomocysteinemia occurs in approximately 41.22and20.61percent of the CI group.Severe(＞100μmol/L)hyperhomocysteinemia occurs in 1.52 percent of the CI group.We found that collagen-induced aggregation of platelets from patients with cerebral infarction was significantly enhanced compared with that of controls(at 100μg/ml,controls=84.36±4.19% and CI=92.59±16.08%;).Similarly,we found that ADP elicited significantly greater aggregation in CI than in control platelets(at 20μmol/L,controls=70.45±13.39%and CI=80.86±15.93%;).Also,aggregation of platelets from patients to epinephrine was significantly enhanced compared with controls(at 3μmol/L,controls,72.47±7.69%;CI,85.37±13.64%).The level of epinephrine induced aggregation of platelets was positive correlation with the concentration of homocysteine(r=0.276,p＜0.05).(2)On multiple logistic regression five risk factors- systolic blood pressure(OR=1.112, 95%CI 1.048-1.180),diastolic blood pressure(OR=1.195,95%CI,1.054-1.355),serum triglyceride(3.924,95%CI 1.420-10.839),serum glucose(OR=4.916,95%CI,1.674-14.433), and fibrinogen(OR=5.050,95%CI,1.987-12.830)were significant. Conclutions:(1)Mild-to-moderate elevated plasma homocysteine is associated with increased risk of cerebral infarction.It may have a critical role in the development of cerebral infarction.The effect of elevated homocysteine affecting the platelets aggregation is multifactorial.(2)Systolic blood pressure,diastolic blood pressure,serum triglyceride,serum glucose, fibrinogen were the most prevalent risk factor in patients with cerebral infarction.