高血压和高同型半胱氨酸血症与静止性脑梗死的相关性分析  

Association of Hypertension and Hyperhomocysteinemia with Silent Brain Infarction in the Healthy

作　　者：郑华光 刘晓楠[2] 张蔚韡[3] 张龙友[2] 王瑞青[2] 孟庆颖[2] 段芸芸[4] 刘亚欧 王拥军 ZHENG Hua-Guang;LIU Xiao-Nan;ZHANG Wei-Wei;ZHANG Long-You;WANG Rui-Qing;MENG Qing-Ying;DUAN Yun-Yun;LIU Ya-Ou;WANG Yong-Jun(National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Health Management Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Physical Examination Center,Beijing 100070,China;Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]国家神经系统疾病临床研究中心,北京100070 [2]首都医科大学附属北京天坛医院健康管理中心 [3]北京市体检中心 [4]首都医科大学附属北京天坛医院影像科 [5]首都医科大学附属北京天坛医院神经病学中心

出　　处：《中国卒中杂志》2020年第8期861-868,共8页Chinese Journal of Stroke

基　　金：国家重点研发计划(2018YFC1311200,2018YFC1311203);首都卫生发展科研专项(2020-2-2244)。

摘　　要：目的调查静止性脑梗死(silent brain infarction,SBI)在健康体检人群中的患病率,分析高血压、高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)与SBI的相关性。方法本研究为单中心横断面研究,前瞻性连续纳入2018年9月-2019年6月既往无明确神经系统疾病的体检者,收集人口学信息,高血压、糖尿病、冠心病等血管危险因素,生活方式及生化检查(包括血浆同型半胱氨酸)等资料。影像学医师采用盲法评价头颅MRI,判断是否存在SBI。按照是否存在高血压和HHcy分为正常、单纯高血压、单纯HHcy、高血压合并HHcy 4组,采用单因素和多因素Logistic回归分析高血压、HHcy与SBI的相关性。结果共纳入577名受试者,平均年龄52.0±10.4岁,女性252名(43.7%)。SBI患病率为8.8%(51/577),高血压、HHcy的患病率分别为20.5%(118/577)和27.6%(159/577),高血压合并HHcy的患病率为8.3%(48/577)。单因素分析显示,单纯HHcy(OR 3.72,95%CI 1.69~8.18,P=0.002),单纯高血压(OR 5.88,95%CI 2.59~13.3,P<0.001),高血压合并HHcy(OR 7.66,95%CI 3.20~18.3,P<0.001)均增加SBI风险。校正混杂因素后,单纯HHcy(OR 2.55,95%CI 1.06~6.11,P=0.036),单纯高血压(OR 3.97,95%CI 1.68~9.43,P=0.001),高血压合并HHcy(OR 3.64,95%CI 1.31~10.1,P=0.013)也均与SBI风险升高有关。单因素分析中高血压和HHcy存在交互作用(P<0.001);在多因素分析中,高血压和HHcy的交互作用差异无统计学意义(OR 0.29,95%CI 0.08~1.09,P>0.05)。结论在健康体检人群中,SBI是一种常见头部影像学改变,高血压和HHcy均与SBI相关。Objective To investigate the prevalence of silent brain infarction(SBI)in the health people,and evaluate the association of hypertension(HT)and hyperhomocysteinemia(HHcy)with SBI.Methods The consecutive participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial from September 2018 to June 2019 were enrolled in a cross-section study.The baseline clinical data were collected.MRI was evaluated by radiologists who were blinded to the clinical data.Univariable analysis and multivariable logistic regression analysis were conducted to analyze the correlation of HT and HHcy with SBI.Results A total of 557 eligible participants were included,with a mean age of 52.0±10.4 years and 252 females(43.7%).The prevalence of SBI,only HT and only HHcy were 8.8%(51/577),20.5%(118/577)and 27.6%(159/577),respectively.The HT concomitant with HHcy occurred in 8.3%(48/577).In the univariable analysis,only HHcy(OR 3.72,95%CI 1.69-8.18,P=0.002),only HT(OR 5.88,95%CI 2.59-13.3,P<0.001),HT concomitant with HHcy(OR 7.66,95%CI 3.20-18.3,P<0.001)all increased the risk of SBI.After adjusting for the confounding factors,the multivariable analysis showed that the only HHcy(OR 2.55,95%CI 1.06-6.11,P=0.036),only HT(OR 3.97,95%CI 1.68-9.43,P=0.001),HT concomitant with HHcy(OR 3.64,95%CI 1.31-10.1,P=0.013)were all associated with SBI.In the univariable analysis,there was interaction between HT and HHcy,while in the multivariable analysis,there was no interaction between them(OR 0.29,95%CI 0.08-1.09,P>0.05).Conclusions SBI is common in neurological health people.Both HT and HHcy were associated with SBI.

关 键 词：静止性脑梗死 高血压 高同型半胱氨酸血症 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R544.1[医药卫生—临床医学]