同型半胱氨酸与脑卒中发生风险相关性分析  

Correlation between homocysteine and the risk of stroke

作　　者：纵振坤[1,2] 庞慧[3,4] 韩冰[3,4] 付强[3,4] 

机构地区：[1]徐州医学院附属医院神经外科,江苏省221002 [2]徐州医学院,江苏省221004 [3]徐州市中心医院心内科,江苏省221009 [4]徐州医学院徐州临床学院,江苏省221009

出　　处：《中华脑科疾病与康复杂志（电子版）》2015年第6期12-16,共5页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的分析高同型半胱氨酸血症(HHcy)患者发生脑卒中的危险因素。方法收集2013年5月至2014年5月在徐州医学院附属医院神经外科及徐州市中心医院心内科住院的1 460例HHcy患者的病例资料,包括年龄、性别、烟酒嗜好、血压、血脂、空腹血糖、同型半胱氨酸(Hcy)以及疾病既往史等,并通过Logistic回归模型和趋势检验对HHcy合并脑卒中的患者进行危险因素分析。结果与未合并脑卒中者相比,865例(59.25%)合并脑卒中者同时罹患高血压、糖尿病的比例明显增加,收缩压、舒张压、空腹血糖、Hcy水平亦显著升高,高密度脂蛋白胆固醇水平降低。并且高血压、糖尿病、收缩压/舒张压、Hcy的升高以及高密度脂蛋白胆固醇的降低是HHcy患者合并脑卒中的独立危险因素。将卒中相关危险因素分层后,通过趋势检验,发现HHcy患者脑卒中患病率随着空腹血糖、收缩压、舒张压的升高而呈现增加的趋势,其中相关性收缩压最强。结论针对卒中的危险因素积极且早期地进行干预,是减少卒中发生,降低卒中负担的有效措施之一。HHcy是脑卒中发生的独立危险因素,对HHcy的严格管理应在脑卒中的一级、二级预防中予以重视。Objective To analyze the correlation between homocysteine （Hcy）and the risk of stroke. Methods The clinical characteristics of 1 460 hyperhomocysteinemia（HHcy） patients were collected from May 2013 to May 2014 in Department of Neumsurgery of Affiliated Hospital of Xuzhou Medical College and Department of Cardiovascular Medicine of Central Hospital of Xuzhou, including age, gender, cigarette smoking, alcohol consumption, blood pressure, blood lipids, fasting glucose, homocysteine, and other complicated diseases. Logistic regression and trend analysis were used to perform the correlation between homocysteine and the risk of stroke. Results HHcy patients with stroke （865 cases, 59. 25% ）had a significantly higher systolic pressure, diastolic pressure, fasting glucose and homoeysteine level than that of patients without stroke, as was also their exposure to hypertension and diabetes mellitus. In binary logistic regression analysis, hypertension, diabetes mellitus, high systolic blood pressure/diastolic blood pressure, elevated Hcy, and decrease in HDL-C level emerged as independent predictors of stroke. An increasing level of Hcy was associated with higher stroke risk due to elevated levels of fasting glucose, systolic blood pressure and diastolic blood pressure by the risk factors stratification. Systolic blood pressure was found to have the highest risk of stroke among the significant independent risk factors. Conclusion Since many vascular risk factors are potentially modifiable, the magnitude of the effect on comprehensive intervention of vascular factors could be growing recognition in the development of stroke. HHey is an independent risk factor for stroke. Given the prevention of stroke in patients with or without stroke, a rigorous management of the elevated serum homocysteine levels should be paid full attention.

关 键 词：脑卒中 危险因素 同型半胱氨酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]