高同型半胱氨酸水平与脑卒中患者心脑血管事件再发风险的关系  

Elevated plasma homocysteine levels contribute to the risk of secondary cardio-cerebrovascular disease in a large prospective stroke population

作　　者：张伟丽[1] 祝立新[1] 孙凯[1] 张春玲[1] 惠汝太 汪道文[1,2] 廖玉华[3] 万鲁虹 

机构地区：[1]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 ,北京100037 [2]华中科技大学同济医学院附属同济医院心血管内科 ,武汉 [3]华中科技大学同济医学院附属协和医院心血管内科 [4]山东兖州矿业集团三十七处医院内科

出　　处：《临床内科杂志》2009年第10期666-668,共3页Journal of Clinical Internal Medicine

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

摘　　要：目的探讨初发脑卒中患者的血浆同型半胱氨酸水平与心脑血管事件再发风险的关系。方法对1823例初发脑卒中患者进行前瞻性随访，Cox生存回归模型分析血浆同型半胱氨酸与心脑血管事件再发风险的关系。结果随访4．5年（中位数0．1～6．0年）过程中，412例发生心脑血管事件，其中347例为脑卒中复发，65例为心肌梗死。与同型半胱氨酸水平最低组比较，校正年龄、性别、吸烟、饮酒等传统危险因素后，高同型半胱氨酸显著增加初发脑卒中患者的心脑血管事件再发风险（风险比1．54，95％可信区间为1．18～2．21）和脑卒中复发风险（风险比1．74，95％可信区间为1．3～2．3）。亚型分析显示，不仅在初发脑梗塞组，而且在初发脑出血组中，高同型半胱氨酸水平与4．5年内的心脑血管事件再发风险均显著相关。结论脑卒中患者血浆同型半胱氨酸水平升高是卒中复发和心脑血管事件再发风险增加的独立危险因素。Objective To assess whether elevated plasma homocysteine levels contribute to the risk of secondary cardio-cerebrovascular disease in a large prospective cohort of patients with first onset stroke. Methods A total of 1823 stroke patients （35-74 years）were recruited during 2000 -2001 and followed up annually until May 31 2006 by a standard questionnaire. Cox proportional-hazards models were used to examine the association between homocysteine and secondary cardio-cerebrovascular disease. Resuits During a median of 4.5 year follow-up,412 secondary cardio-cerebrovascular diseases were documented, including 347 recurrent strokes and 65 coronary heart diseases. After adjustment for age, sex, and conventional vascular risk factors, high homocysteine concentration was associated with increased risk of 1.54 fold for secondary cardio-cerebrovascular disease[ relative risk （RR） 1.54,95% CI 1.18-2.21 ;P 〈 0.01 ] and 1.74 fold for stroke recurrence（ RR 1.74,95% CI 1.3-2.3 ;P 〈 0.001 ） in comparison of the highest to lowest category. Conclusions Our findings suggest that elevated plasma homocysteine levels are associated with increased risk of secondary cardio-cerebrovascular disease and stroke recurrence in the patients with first onset stroke.

关 键 词：同型半胱氨酸 脑卒中 卒中复发 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]