The Relation Between Hyperhomocystinemia And Cerebral Infarction And The Intervention Study Of Enalapril Maleate Folic Acid Tablets

Objective:The study is aimed to investigate the relation between hyperhomocystinemia(Hyperhomocystinemia,HHcy) and cerebral infarction,and to survey the risk ofrecurrent cerebral infarction to the patient suffered from HHcy as well,and to provideevidence for the drug prevention and cure of cerebral infarction,further more, to guidethe clinical medication,by means of studying the influence of Enalapril maleate folicacid tablets on patients’serum homocystinemia(Homocystinemia,Hcy) with acutecerebral infarction,suffered from HHcy and hypertension at the same time,and scoringall patients by NIH Stroke Scale (NIH Stroke Scale,NIHSS), Barthel Index(BarthelIndex,ADL) and Modified Rankin Scale(Modified Rankin Scale,mRS).Methods:The number of all patients selected with acute cerebral infarction is127in total.1.All patients are finished the basical table of stroke screening cases,whichcontain basical information and anamnesis.(See Appendix);2.All are examed by CT，MRI and carotid ultrasound,scored by NIHSS，ADL，mRS,and finished Oxfordshire Community Stroke Project（Oxfordshire CommunityStroke Project，OCSP)，TOAST et al.All are exsanguinated on empty stomach toexam some laboratory indexes,such as blood fat,hcy and so on,at the very next daymorning,and all veinal blood is exsanguinated to4ml every indexe,installed in EDTArubber tube which are anti coagulation,and is parted to plasma and then are frozed tobe kept on.3.All are parted to some groups: Difference of age is:≤45,46-64,65-75and≥76; blood pressure:high and regular; the result of carotid ultrasound:have plaqueand no;④the result of OCSP:Total anterior airculation infarct(Total anteriorairculation infarct, TACI),Partial anterior airculation infarct(Partial anteriorairculation infarct, PACI),Posterior circulation infarct(Posterior circulation infarct,POCI),Lacunar infarct(Lacunar infarct, LACI);⑤the result of TOAST:Large-artery Atherosclerosis (Large-artery atherosclerosis, LAA), Cardioembolism(Cardioembolism,CE),Small-artery occlusion Lacunar(Small-artery occlusion lacunar,SAA),Acute stroke of other determined etiology(Acute stroke of other determinedetiology,SOE),Stroke of other undetermined etiology(Stroke of other undeterminedetiology,SUE)⑥the result of NIHSS:mild,moderate,severe;⑦drugs to intervene:routine treatment(acute cerebral infarction with no hhcy or no hypertension),folic acidtablets to intervene(acute cerebral infarction with hhcy and normal bloodpressure),enalapril maleate to intervene(acute cerebral infarction withhypertensionbut no hhcy) and enalapril maleate folic acid tablets to intervene(acutecerebral infarction with hhcy and hypertension);all groups are based on the routinetreatment which include:platelet aggregation,anti oxygen free radicals,improve bloodcirculation and so on.4.Give the drugs according to3-⑦,and all are exsanguinated again after2weeks,on empty stomach to exam the laboratory indexes the same as2weeksbefore,and scored by NIHSS,ADL,mRS again.5.Followed up to survey in3months,and all are exsanguinated again in a monthand3months on empty stomach to exam the laboratory indexes the same as thebeginning,meanwhile scored by NIHSS,ADL,mRS again in a month and3months.6.Use of relevant statistical theory,to analysis the relation between hhcy andcerebral infarction,the relativity between hhcy and other risk factors of cerebralinfarction,and to compare with the change on drug intervention of hhcy,NIHSS,ADL,mRS and so on.7.Data analysis using statistical software SPSS17.0.Results:1.The level of hcy which grouped by the age of the patients with cerebralinfarction have has no significant statistical difference;2.The level of hcy which grouped by the result of carotid ultrasound is haveplaque or no has no significant statistical difference;3.The level of hcy which grouped by the result of TOAST and OCSP hasdifference: the level of hcy which grouped by the result of TOAST has significantstatistical difference, the level of hcy which CE have is hignest,SAA and LAA are the next,SUE and SOE are lowest;and the level of hcy which grouped by the result ofOCSP has significant statistical difference,the level of hcy which TACI and POCIhave are higner than PACI and LACI;4.The level of hcy which grouped by the result of NIHSS has significantstatistical difference: the level of hcy which the result of NIHSS is severe is clearlyhigner than moderate and mild,the result of NIHSS is mild lowest;5.The level of hcy which grouped by recurrent cerebral infarction or no hassignificant statistical difference:followed up to survey in a month,the level of hcywhich recurrent cerebral infarction have is higner than non recurrent in themonth;followed up to survey in3months,the level of hcy which recurrent cerebralinfarction have is higner than non recurrent before2months and at the moment ofrecurrent;6.In study on the correlation between the level of hcy and other classical riskfactors of cerebral infarction,the level of hcy between hypertension or no hassignificant statistical difference,and the same as the level of hcy betweenhyperlipemia or no;7.The level of hcy which grouped by different treatment has significantstatistical difference:the level of hcy which folic acid tablets and enalapril maleatefolic acid tablets to intervene both are lowed clearly,but the level of hcy which routinetreatment and enalapril maleate to intervene have the increasing trend;8.The result of NIHSS,ADL and mRS which grouped by different treatment hasno significant statistical difference;and the result of NIHSS,ADL and mRS whichgrouped before and after drug treatment has significant statistical difference,the scoreof NIHSS and mRS become smaller,ADL greater gradually.Conclusion:1.Hhcy maybe is the importance risk factor for recurrent cerebral infarction;2.The level of hcy in acute cerebral infarction can indicates the degree of neuralfunction defect:The higher the level of hcy, the more severe the neural functiondefect; 3.Folic acid tablets and enalapril maleate folic to intervene on acute cerebralinfarction both reduce the level of hcy,and the same time to improve the patient’snerve function;4.The blood pressure and the blood fat of cerebral infarction both are one of therisk factors;5.The nosogenesis of cerebral infarction which hcy leads to maybe is related tolarge artery injury;6.The level of hcy maybe is related to the lesion size of cerebral infarction.