摘要
目的探讨血浆同型半胱氨酸（Hcy）水平与急性缺血性脑卒中患者卒中复发及死亡的关系。方法连续选择自2005年9月至2011年3月天津市环湖医院神经内科收治的3799例首发缺血性脑卒中住院患者，收集其人口学信息及临床资料。所有患者在人院24h内测定血浆Hcy水平，根据Hcy水平分为正常Hcy组（Hcy〈15μmol／L，n=2267）和高同型半胱氨酸血症（1alacy）组（Hcy≥15μmol／L，n=1532）。对入组患者随访3年，采用COX比例风险回归模型分析Hcy水平与脑卒中复发及死亡的关系。结果经过3年随访，702例患者脑卒中复发．303例患者死亡。HHcy组比正常Hcy组的脑卒中复发率（21．8％VS．16．2％）和死亡率（11．2％vs．5．8％）明显增高，差异有统计学意义（P〈0．05）。调整年龄、性别、糖尿病、高脂血症、饮酒、吸烟、高尿酸血症、低密度脂蛋白、载脂蛋白B／载脂蛋白AI比值、空腹血糖等危险因素后，HHcy组比正常Hcy组的脑卒中复发风险[风险比（HR）=1．101，95％可信区间（CI）=1．037～1．257，P=0．0021和死亡风险（HR：1．701．95％CI=1．040～2．283，P=0．000）均显著增加，差异有统计学意义。进一步亚组分析表明．大动脉粥样硬化性脑卒中亚组中，HHcy组的脑卒中复发风险（调整后HR=1．071，95％CI=1．037～1．106，P=0．003）和死亡风险（HR=1．860，95％CI=1．120-2．970，P=0．001）,显著高于正常Hcy组，差异有统计学意义；而在小血管闭塞性脑卒中亚组中，HHcy组与正常Hcy组脑卒中复发风险fHR=0．731，95％CI=0．043～1．205．P=0．058）和死亡风险（HR=0．770，95％CI=0．290-2．340，P=0．061）差异无统计学意义。结论Hcy水平是急性缺血性脑卒中患者卒中复发及死亡的危险因素。
Objective To investigate whether homocysteine （Hey） level in the acute phase of stroke influences the recurrence of stroke and mortality of the patients. Methods A total of 3799 patients with first-onset ischemic stroke, admitted to our hospital from September 2005 to March 2011, were recruited; their demographic information, comorbidities, and clinical data were collected; Hey level was measured within 24 h of primary admission. According to the Hey level, patients were divided into normal Hcy group （Hcy〈15 μmoL/L, r2=2267）, and hyperhomocysteinemia （HHcy） group （Hey ≥ 15 μmooL, n=1532）. Patients were followed up for three years, univariate analysis and Cox proportional hazards regression analysis were used to analyze the relations of Hcy level with recurrence and mortality. Results During the three years of follow-up, 702 patients suffered recurrent stroke, and 303 died. The HHcy group had significantly higher recurrence stroke rate （21.8% vs. 16.2%） and mortality （11.2% vs.5.8%） than the normal Hcy group （P〈0.05）. After being adjusted for age, gender, diabetes, hyperlipidemia, drinking, smoking, hyperuricemia, low density lipoprotein level, apolipoprotein Blapolipoprotein AI ratio and fasting blood glucose level, patients in the HHcy group had significantly increased risk of recurrent stroke （hazard ratio [HR]= 1.10 1, 95% CI： 1.037-1.257, P=0.002） and mortality （HR=1.701, 95%CI： 1.040-2.283, P=0.000） than patients in the normal Hey group. Further subgroup analysis showed that this correlation was only significant in the large artery atherosclerosis stroke subtype： the recurrent stroke risk （adjusted HR=1.071, 95% CI： 1.037-1.106, P=-0.003） and mortality risk （HR=1.86, 95%CI： 1.12-2.97, P=0.001） in the HHcy group were significantly higher than those in normal Hcy group; however, in small-vessel occlusion subtype, the risk of recurrence stroke （HR=0.731, 95%CI： 0.043-1.205, P=0.058） and mortality risk（HR=0.77, 95% CI： 0.29-2.34, P=0.061） in the HHcy group were not significant as compared with those in the normal Hey group. Conclusions Hey level is a risk factor for stroke recurrence and mortality in patients with acute ischemic stroke.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2016年第7期654-659,共6页
Chinese Journal of Neuromedicine
