岳伟; 吴昊; 石志鸿; 张雅静; 王慧; 李新; 王林; 纪勇

doi:10.3760/cma.j.issn.1671-8925.2016.07.002

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• 脑血管病 •

血浆同型半胱氨酸水平与急性缺血性脑卒中患者的卒中复发及死亡关系的研究

中华神经医学杂志, 2016,15(7) : 654-659. DOI: 10.3760/cma.j.issn.1671-8925.2016.07.002

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。所有患者在入院24 h内测定血浆Hcy水平，根据Hcy水平分为正常Hcy组(Hcy<15 μmol/L，n=2267)和高同型半胱氨酸血症（HHcy)组(Hcy≥15 μmol/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=0.002]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（HR=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。

引用本文: 岳伟, 吴昊, 石志鸿, 等. 血浆同型半胱氨酸水平与急性缺血性脑卒中患者的卒中复发及死亡关系的研究 [J] . 中华神经医学杂志, 2016, 15(7) : 654-659. DOI: 10.3760/cma.j.issn.1671-8925.2016.07.002.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

脑卒中是世界范围内的重大致死性疾病，在我国已成为首要死亡原因，其发病率、致残率及复发率均高，长期生存率低，给家庭和社会带来极大的负担^[1,2]。尽早识别脑卒中危险因素是预防脑卒中的有效方法。目前很多研究表明高同型半胱氨酸血症(hyperhomocysteinemia，HHcy）是缺血性脑卒中的危险因素，通过多种机制促进动脉粥样硬化形成，增加脑卒中风险^[3,4]。研究显示同型半胱氨酸(homocysteinemia，Hcy）升高5 mmol/L后，相对原基础水平发生缺血性脑卒中的比值比升高至1.49(95%CI =1.01~2.18)^[5]；Hcy水平每降低25%，脑卒中风险则降低11%~16%^[6,7]。HHcy可能是缺血性脑卒中患者复发及不良预后的危险因素^[8,9]，缺血性脑卒中患者发病时血浆Hcy水平越高，神经功能缺损程度越严重。即使给予积极有效治疗降低脑卒中患者血浆Hcy水平，HHcy组患者的神经功能缺损仍然较正常Hcy组严重，Hcy水平与缺血性脑卒中患者的预后有关。为进一步明确这种联系，本研究采用前瞻性队列研究方法，探究血浆Hcy水平与急性缺血性脑卒中患者卒中复发及死亡的关系。

贡献者信息

岳伟

300060　天津市环湖医院神经内科

吴昊

300060　天津市环湖医院神经内科

石志鸿

300060　天津市环湖医院神经内科

张雅静

300060　天津市环湖医院神经内科

王慧

300060　天津市环湖医院神经内科

李新

300211　天津，天津医科大学第二医院神经内科

王林

300211　天津，天津医科大学第二医院神经内科

纪勇

300060　天津市环湖医院神经内科

通信作者

纪勇

300060　天津市环湖医院神经内科

Email：jiyonggusa@126.com

关键词

同型半胱氨酸; 急性缺血性脑卒中; 卒中复发; 死亡率; 预后;

历史

出版日期：2016-07-15

收稿日期：2016-01-09

本文编辑

张玲

Relationships between plasma homocysteine level and both recurrence and mortality in patients with acute ischemic stroke

Yue Wei, Wu Hao, Shi Zhihong, Zhang Yajing, Wang Hui, Li Xin, Wang Lin, Ji Yong

Published 2016-07-15

Cite as Chin J Neuromed, 2016, 15(7): 654-659. DOI: 10.3760/cma.j.issn.1671-8925.2016.07.002

Abstract

Objective

To investigate whether homocysteine (Hcy) 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; Hcy level was measured within 24 h of primary admission. According to the Hcy level, patients were divided into normal Hcy group (Hcy<15 μmol/L,n=2267), and hyperhomocysteinemia (HHcy) group (Hcy≥15 μmol/L, 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 B/apolipoprotein AI ratio and fasting blood glucose level, patients in the HHcy group had significantly increased risk of recurrent stroke (hazard ratio[HR]=1.101, 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 Hcy 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 Hcy group.

Conclusions

Hcy level is a risk factor for stroke recurrence and mortality in patients with acute ischemic stroke.

Key words:

Homocysteine; Acute ischemic stroke; Recurrent stroke; Mortality; Prognosis

Contributor Information

Yue Wei