血浆高同型半胱氨酸与初发卒中患者心脑血管疾病死亡风险的关系  

Elevated Plasma Homocysteine Levels Contribute to the Risk of Cardio-cerebrovascular Mortality in a Large Prospective Stroke Population

作　　者：万鲁虹 张伟丽[2] 祝立新[2] 孙凯[2] 廖玉华[3] 汪道文[4] 惠汝太 

机构地区：[1]山东兖州矿业集团三十七处医院,山东省兖州市273500 [2]中国医学科学院阜外心血管病医院心血管病相关基因与临床研究教育部重点实验室(中德分子医学研究室) [3]华中科技大学同济医学院附属协和医院心血管内科 [4]华中科技大学同济医学院附属同济医院心血管内科

出　　处：《中国卒中杂志》2009年第9期747-751,共5页Chinese Journal of Stroke

基　　金：国家自然科学基金资助项目(30670862);国家973重点基础研究发展规划基金资助项目(G2006CB503805)

摘　　要：目的探讨初发卒中患者的血浆同型半胱氨酸水平与心脑血管死亡风险的关系。方法对1823例卒中病例队列(包括808例动脉粥样硬化性血栓性脑梗死、513例腔隙性脑梗死和502例脑出血)进行长期的前瞻性随访,Cox生存回归模型分析血浆同型半胱氨酸水平与总死亡和心脑血管死亡风险的相关性。结果随访0.1～6.0年(中位数4.5年),323例卒中病例死亡,其中183例死于心脑血管疾病。与血浆同型半胱氨酸<16μmol/L组比较,同型半胱氨酸≥16μmol/L组患者死亡风险显著增加,校正年龄、性别和传统心血管危险因素后,相对风险为1.47(95%可信区间1.15～1.88)。进一步分析表明血浆高同型半胱氨酸与卒中患者总死亡的相关性主要是由于心脑血管疾病死亡,相对风险为1.33(95%可信区间1.06～1.65)。亚型分析显示,血浆高同型半胱氨酸与脑梗死组和脑出血组的心脑血管疾病死亡风险均显著相关。结论血浆同型半胱氨酸水平升高是卒中患者心脑血管疾病死亡风险增加的独立预测因素。Objective To assess whether elevated plasma homocysteine levels contribute to the risk of cardio-cerehrovascular mortality in a large prospective cohort of patients with first onset stroke in Chinese population. Methods A total of 1,823 patients with first onset stroke（35-74 years） were recruited during 2000-2001, including 808 paitents with cerebral thrombosis, 513 paitents with lacunar infarction, and 502 patients with intracerebral hemorrhage. These stroke patients were followed up annually until May 31, 2006 by a standard questionnaire and telephone contact by physician investigators. Cox proportional-hazards models were used to examine the association between homocysteine（Hcy） and all-cause or cardio-cerebrovascular mortality. Results During a median of 4.5-year follow-up, a total of 323 deaths from all causes were documented, including 183 deaths from recurrent stroke and coronary heart disease. After adjustment for age, sex, and conventional vascular risk factors, high Hcy level（〉16 μmol/L） was significantly associated with increased risk of all-cause mortality[relative risk（RR） 1.47, 95% confidence interval（CI） 1.15-1.88] as compared with lower Hcy level（〈16μmol/L）. The association with all-cause mortality was mainly due to a positive association between homocysteine and the risk of cardiovascular deaths, and RR was 1.33（95%CI 1.06-1.65）. Stroke subtype analysis showed that high Hcy level increased the risk of cardiovascular deaths not only in the patients with atherothrombotic stroke but also in those with hemorrhagic stroke. Conclusion Our findings suggest that elevated plasma homocysteine levels are independently associated with increased risk of cardio-cerebrovascular mortality in the patients with first onset stroke.

关 键 词：半胱氨酸 卒中 血管疾病 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R54[医药卫生—临床医学]