同型半胱氨酸对高血压患者脑卒中复发风险的影响
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摘要
目的探讨高血压合并脑卒中患者的血浆同型半胱氨酸(Hcy)水平与其他危险因素对于脑卒中复发的影响。方法分析徐州市中心医院心内科和徐州医科大学附属医院神经外科自2012年5月至2013年12月收治的1623例高血压脑卒中患者的基线资料,中位随访4.9年,根据随访事件中是否发生脑卒中分为复发组(312例)与未复发组(1311例)。Kaplan-Meier生存分析比较不同危险因素脑卒中复发率的差异,单因素与多因素Cox回归模型分析影响脑卒中复发的独立危险因素,以及危险因素之间的交互作用。结果复发组年龄、空腹血糖、Lg Hcy的水平,以及糖尿病、房颤的患病率均高于未复发组(P<0.05)。Kaplan-Meier生存分析显示,糖尿病、房颤、年龄≥60岁、空腹血糖≥7.0 mmol/L、Hcy≥15μmol/L的脑卒中复发率明显升高(Log-rank检验,P<0.05)。多因素Cox回归模型分析显示,高龄、Lg Hcy水平升高,以及房颤、糖尿病是脑卒中复发的独立危险因素。Lg Hcy分别与糖尿病、空腹血糖、年龄存在交互作用。结论血浆Hcy水平升高既是高血压合并脑卒中患者卒中复发的独立危险因素,又通过与糖尿病、高龄、空腹血糖水平升高的交互作用显著增加脑卒中复发风险。
Objective To explore both homocysteine(Hcy) and other risk factors for the recurrent stroke in patients with stroke and hypertension. Methods A total of 1623 hospitalized patients with stroke and hypertension recruited from Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University and Department of Cardiology, Xuzhou Central Hospital were analyzed.During a median follow-up period of 4.9 years, patients were divided into the recurrence group with 312 patients and the non-recurrence group with 1311 patients according to achieved follow-up recurrent stroke. The Kaplan-Meier method was used to estimate the cumulative incidences of recurrent stroke among subgroups. Independent risk factors and their interactions with recurrent stroke were identified by uni-and multi-variate Cox regression analysis with the baseline clinical characteristics. Results Compared with the non-recurrence group, patients in the recurrence group were older with higher level of fasting plasma glucose and Lg Hcy, and higher proportion of previous history of diabetes mellitus and atrial fibrillation(P<0.05). Subgroup analysis showed patients with diabetes mellitus, atrial fibrillation,age ≥60 years fasting plasma glucose ≥7.0 mmol/L, and Hcy ≥15 μmol/L have a higher incidence of recurrence than other groups. Multi-variate Cox regression analysis showed that older patients, elevated Lg Hcy levels, diabetes mellitus and atrial fibrillation were independent risk factors for recurrent stroke in patients with stroke and hypertension. Furthermore, the interactions between Lg Hcy and other risk factors were statistically significant: diabetes mellitus, fasting plasma glucose and age. Conclusion Hcy is not only an independent risk factor, but also interactions with other risk factors on recurrent stroke in patients with stroke and hypertension.
Objective To explore both homocysteine(Hcy) and other risk factors for the recurrent stroke in patients with stroke and hypertension. Methods A total of 1623 hospitalized patients with stroke and hypertension recruited from Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University and Department of Cardiology, Xuzhou Central Hospital were analyzed.During a median follow-up period of 4.9 years, patients were divided into the recurrence group with 312 patients and the non-recurrence group with 1311 patients according to achieved follow-up recurrent stroke. The Kaplan-Meier method was used to estimate the cumulative incidences of recurrent stroke among subgroups. Independent risk factors and their interactions with recurrent stroke were identified by uni-and multi-variate Cox regression analysis with the baseline clinical characteristics. Results Compared with the non-recurrence group, patients in the recurrence group were older with higher level of fasting plasma glucose and Lg Hcy, and higher proportion of previous history of diabetes mellitus and atrial fibrillation(P<0.05). Subgroup analysis showed patients with diabetes mellitus, atrial fibrillation,age ≥60 years fasting plasma glucose ≥7.0 mmol/L, and Hcy ≥15 μmol/L have a higher incidence of recurrence than other groups. Multi-variate Cox regression analysis showed that older patients, elevated Lg Hcy levels, diabetes mellitus and atrial fibrillation were independent risk factors for recurrent stroke in patients with stroke and hypertension. Furthermore, the interactions between Lg Hcy and other risk factors were statistically significant: diabetes mellitus, fasting plasma glucose and age. Conclusion Hcy is not only an independent risk factor, but also interactions with other risk factors on recurrent stroke in patients with stroke and hypertension.
引文
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[16]Zinman B,Inzucchi SE,Lachin JM,et al.Empagliflozin and cerebrovascular events in patients with type 2 diabetes mellitus at high cardiovascular risk[J].Stroke,2017,48(5):1218-1225.
[17]Yang N,Yao Z,Miao L,et al.Novel clinical evidence of an association between homocysteine and insulin resistance in patients with hypothyroidism or subclinical hypothyroidism[J].PLoS One,2015,10(5):e0125922.
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[19]Meng Y,Li J,Chen X,et al.Association between folic acid supplementation and retinal atherosclerosis in chinese adults with hypertension complicated by diabetes mellitus[J].Front Pharmacol,2018,9:1159.
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[21]Jin C,Li G,Rexrode KM,et al.Prospective study of fasting blood glucose and intracerebral hemorrhagic risk[J].Stroke,2018,49(1):27-33.
[22]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.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.
[2]李建平,卢新政,霍勇,等.H型高血压诊断与治疗专家共识[J].中华高血压杂志,2016,24(2):123-127.
[3]《中国高血压防治指南》修订委员会.中国高血压防治指南2018年修订版[J].心脑血管病防治,2019,19(1):1-44.
[4]Meschia JF,Bushnell C,Boden-Albala B,et al.Guidelines for the primary prevention of stroke:a statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(12):3754-3832.
[5]Li T,Zhu J,Fang Q,et al.Association of H-type hypertension with stroke severity and prognosis[J].Biomed Res Int,2018,2018:8725908.
[6]纵振坤,庞慧,韩冰,等.血压水平与高血压脑卒中发病风险的关系研究[J].中华神经创伤外科电子杂志,2015,1(5):260-264.
[7]Anniwaer J,Liu MZ,Xue KD,et al.Homocysteine might increase the risk of recurrence in patients presenting with primary cerebral infarction[J].Int J Neurosci,2019,8:1-6.
[8]Mathisen SM,Dalen I,Larsen JP,et al.Long-term mortality and its risk factors in stroke survivors[J].J Stroke Cerebrovasc Dis,2016,25(3):635-641.
[9]Moretti R,Caruso P.The controversial role of homocysteine in neurology:from labs to clinical practice[J].Int J Mol Sci,2019,20(1):pii E231.
[10]Xu B,Kong X,Xu R,et al.Homocysteine and all-cause mortality in hypertensive adults without pre-existing cardiovascular conditions:effect modification by MTHFR C677T polymorphism[J].Medicine(Baltimore),2017,96(8):e5862.
[11]Qin X,Huo Y.H-Type hypertension,stroke and diabetes in China:Opportunities for primary prevention[J].J Diabetes,2016,8(1):38-40.
[12]张澍,杨艳敏,黄从新,等.中国心房颤动患者卒中预防规范(2017)[J].中华心律失常学杂志,2018,22(1):17-30.
[13]Reiffel JA.Complexities in the atrial fibrillation-stroke relationship:improving comprehension of temporal discordance,magnitude synergism,and subclinical atrial fibrillation-three sources of consternation for physicians who care for patients with atrial fibrillation[J].J Atr Fibrillation,2018,11(2):2100.
[14]Hyman DA,Siebert V,Jia X,et al.Risk assessment of stroke in patients with atrial fibrillation:current shortcomings and future directions[J].Cardiovasc Drugs Ther,2019,33(1):105-117.
[15]Zhang W,Xiong Y,Yu L,et al.Meta-analysis of stroke and bleeding risk in patients with various atrial fibrillation patterns receiving oral anticoagulants[J].Am J Cardiol,2019,123(6):922-928.
[16]Zinman B,Inzucchi SE,Lachin JM,et al.Empagliflozin and cerebrovascular events in patients with type 2 diabetes mellitus at high cardiovascular risk[J].Stroke,2017,48(5):1218-1225.
[17]Yang N,Yao Z,Miao L,et al.Novel clinical evidence of an association between homocysteine and insulin resistance in patients with hypothyroidism or subclinical hypothyroidism[J].PLoS One,2015,10(5):e0125922.
[18]Chen R,Ovbiagele B,Feng W.Diabetes and stroke:epidemiology,pathophysiology,pharmaceuticals and outcomes[J].Am J Med Sci,2016,351(4):380-386.
[19]Meng Y,Li J,Chen X,et al.Association between folic acid supplementation and retinal atherosclerosis in chinese adults with hypertension complicated by diabetes mellitus[J].Front Pharmacol,2018,9:1159.
[20]Kim MK,Han K,Park YM,et al.Associations of variability in blood pressure,glucose and cholesterol concentrations,and body mass index with mortality and cardiovascular outcomes in the general population[J].Circulation,2018,138(23):2627-2637.
[21]Jin C,Li G,Rexrode KM,et al.Prospective study of fasting blood glucose and intracerebral hemorrhagic risk[J].Stroke,2018,49(1):27-33.
[22]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.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.