Clinical value of homocysteine combined with blood lipid indexes in identifying vascular lesion subtypes of cerebral infarction in young and middle-aged and pre-elderly adults

Objective: To investigate the diagnostic value of homocysteine (Hcy) combined with lipid indicators for TOAST subtypes in young, middle-aged, and pre-elderly cerebral infarction, and to establish and validate a predictive model for large artery atherosclerosis (LAA).Methods: A total of 163 patients were retrospectively enrolled.Hcy, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were compared among subtypes.A Logistic model was constructed using Hcy, LDL-C, and HDL-C, and validated by internal validation, 5-fold cross-validation, and external validation (n = 80).Results: Hcy, LDL-C, and HDL-C differed significantly among subtypes (P < 0.05).The combined index showed the best performance for LAA (AUC = 0.876, sensitivity = 84.6%,specificity = 78.8%).All three indicators were independent predictors.The model performed well in internal validation (mean AUC = 0.956) and external validation (AUC = 0.929, accuracy = 86.3%).Conclusions: Hcy combined with LDL-C and HDL-C is effective in identifying LAA.The model shows good stability and generalization ability, which can support clinical screening and individualized management.