正常范围同型半胱氨酸不同水平与复发性脑梗死的相关性研究
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摘要
目的探讨正常范围同型半胱氨酸(homocysteine,Hcy)水平与复发性脑梗死之间的关系。方法选取2015年6月-2017年6月河南省中医药大学第一附属医院600例急性脑梗死患者作为研究对象,分为大动脉粥样硬化性脑梗死组、脑栓塞组、小动脉闭塞性脑梗死组,同时根据有无脑梗死病史再分为初发组与复发组。再抽出同期住院的200例非急性脑血管病患者为对照组,比较不同类型卒中患者血浆Hcy水平,初发和复发患者血浆Hcy水平和正常范围Hcy高水平(10μmol/L性脑梗死组、脑栓塞组、小动脉闭塞性脑梗死组与对照组的Hcy水平比较,差异均有统计学意义(P<0.05);初发组正常范围Hcy高水平患者(25.4%)比例低于复发组(35.1%),比较差异有统计学意义(χ~2=6.171,P=0.013)。多因素Logistic回归分析结果显示,正常范围Hcy高水平和高血压是复发性脑梗死的独立危险因素。结论正常范围Hcy高水平仍是复发性脑梗死的危险因素之一,有效控制脑梗死患者Hcy在正常范围内是缺血性脑血管病二级预防的新途径。
Objective To investigate the relationship between normal homocysteine(Hcy) levels and recurrent cerebral infarction.Methods 600 patients with acute cerebral infarction from the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2015 to June 2017 were included in this study. According to the pathogenesis, all the patients were divided into large artery atherosclerosis group, cerebral embolism group and cerebral small artery occlusion group. According to medical history, the patients were divided into first stroke group and recurrent stroke group. 200 inpatients without acute cerebrovascular diseases during the same period were selected as control group. The plasma Hcy levels of different groups were compared. The proportion of high-normal Hcy level(10 μmol/L < Hcy < 15 μmol/L) in the first and recurrent stroke groups were compared.Results The level of Hcy in large artery atherosclerosis group, cerebral embolism group, cerebral small artery occlusion group were significantly different with that in control group(P <0.05). The proportion of high-normal Hcy level in first stroke group(25.4%) was lower than that in recurrent stroke group(35.1%), and the difference was statistically significant(χ~2=6.171, P=0.013). Multivariate logistic regression analysis showed that high-normal Hcy level and hypertension were independent risk factors of recurrent cerebral infarction.Conclusions The high-normal Hcy level is one of risk factors of recurrent cerebral infarction.Effective control of Hcy level in patients with cerebral infarction is a new approach of secondary prevention for ischemic stroke.
Objective To investigate the relationship between normal homocysteine(Hcy) levels and recurrent cerebral infarction.Methods 600 patients with acute cerebral infarction from the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2015 to June 2017 were included in this study. According to the pathogenesis, all the patients were divided into large artery atherosclerosis group, cerebral embolism group and cerebral small artery occlusion group. According to medical history, the patients were divided into first stroke group and recurrent stroke group. 200 inpatients without acute cerebrovascular diseases during the same period were selected as control group. The plasma Hcy levels of different groups were compared. The proportion of high-normal Hcy level(10 μmol/L < Hcy < 15 μmol/L) in the first and recurrent stroke groups were compared.Results The level of Hcy in large artery atherosclerosis group, cerebral embolism group, cerebral small artery occlusion group were significantly different with that in control group(P <0.05). The proportion of high-normal Hcy level in first stroke group(25.4%) was lower than that in recurrent stroke group(35.1%), and the difference was statistically significant(χ~2=6.171, P=0.013). Multivariate logistic regression analysis showed that high-normal Hcy level and hypertension were independent risk factors of recurrent cerebral infarction.Conclusions The high-normal Hcy level is one of risk factors of recurrent cerebral infarction.Effective control of Hcy level in patients with cerebral infarction is a new approach of secondary prevention for ischemic stroke.
引文
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[13]BANECKA-MAJKUTEWICZ Z,SAWU?A W,KADZI?SKI L,et al. Homocysteine,heat shock proteins,genistein and vitamins in ischemic stroke--pathogenic and therapeutic implications[J]. Acta Biochim Pol,2012,59(4):495-499.
[14]SIGNORELLO M G,SEGANTIN A,PASSALACQUA M,et al. Homocysteine decreases platelet NO level via protein kinase C activation[J].Nitric Oxide. 2009,20(2):104-113.
[15]ZHANG D,XIE X,CHEN Y,et al. Homocysteine upregulates soluble epoxide hydrolase in vascular endothelium in vitro and in vivo[J]. Cire Res,2012,110(6):808-817.
[16]BOGDANSKI P,MILLER-KASPRZAK E,PUPEK-MUSIALIK D,et al. Plasma total homocysteine is a determinant of carotid intimamedia thickness and circulating endothelial progenitor cells in patients with newly diagnosed hypertension[J]. Clin Chem Lab Med,2012,50(6):1107-1113.
[2]ZHAO M,WANG X,HE M,et al. Homocysteine and stroke risk:modifying effect of methylenetetrahydrofolate reductase C677T polymorphism and folic acid intervention[J]. Stroke,2017,48(5):1183-1190.
[3]WANG Y,ZHANG J,QIAN Y,et al. Association of homocysteine with aysmptomatic intracranial and extracranial arterial stenosis in hypertension patients[J]. Sci Rep,2018,8(1):595.
[4]SHI Z,GUAN Y,HUO Y R,et al. Elevated total homocysteine levels in acute ischemic stroke are associated with long-term mortality[J]. Stroke,2015,46(9):2419-2425.
[5]WELCH G N,LOSCALZO J. Homocysteine and atherothrombosis[J]. N Engl J Med,1998,338(15):1042-1050.
[6]PANG H,HAN B,FU Q,et al. Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension[J]. Sci Rep,2018,8(1):3900.
[7]KUMRAL E,SARUHAN G,AKTERT D,et al. Association of Hyperhomocysteinemia with Stroke Recurrence after Initial Stroke[J]. J Stroke Cerebrovasc Dis,2016,25(8):2047-2054.
[8]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[9]JACQUES P F,BOSTOM A G,WILSON P W,et al. Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort[J]. Am J Clin Nutr,2001,73(3):613-621.
[10]BOYSEN G,BRANDER T,CHRISTENSEN H,et al. Homocysteine and risk of recurrent stroke[J].Stroke,2003,34(5):1258-1261.
[11]WANG W,GAO C,YU C,et al. No association between elevated total homocysteine levels and functional outcome in elderly patients with acute cerebral infarction[J/OL]. Front Aging Neurosci,2017,9:70. https://doi.org/10.3389/fnagi.2017.00070.
[12]CHENGFENG S,WEI L,XINXING W,et al.Hyperhomocysteinemia is a result,rather than a cause,of depression under chronic stress[J].PLoS One,2014,9(10):e106625. https://doi.org/10.1371/journal.pone.0106625.
[13]BANECKA-MAJKUTEWICZ Z,SAWU?A W,KADZI?SKI L,et al. Homocysteine,heat shock proteins,genistein and vitamins in ischemic stroke--pathogenic and therapeutic implications[J]. Acta Biochim Pol,2012,59(4):495-499.
[14]SIGNORELLO M G,SEGANTIN A,PASSALACQUA M,et al. Homocysteine decreases platelet NO level via protein kinase C activation[J].Nitric Oxide. 2009,20(2):104-113.
[15]ZHANG D,XIE X,CHEN Y,et al. Homocysteine upregulates soluble epoxide hydrolase in vascular endothelium in vitro and in vivo[J]. Cire Res,2012,110(6):808-817.
[16]BOGDANSKI P,MILLER-KASPRZAK E,PUPEK-MUSIALIK D,et al. Plasma total homocysteine is a determinant of carotid intimamedia thickness and circulating endothelial progenitor cells in patients with newly diagnosed hypertension[J]. Clin Chem Lab Med,2012,50(6):1107-1113.