上海市农村脑卒中高危人群血清同型半胱氨酸水平的分析  

Blood homocysteine level in Shanghai rural residents with high risk of stroke

作　　者：胡卫华 徐珏 裴文建 沈莉 宋海虹 HU Wei-hua;XU Jue;PEI Wen-jian;SHEN Li;SONG Hai-hong(Luojing Community Health Center,Shanghai 200949,China;Gucun Community Health Center,Shanghai 201906,China;Songnan Community Health Center,Shanghai 200441,China)

机构地区：[1]上海市宝山区罗泾镇社区卫生服务中心,上海200949 [2]上海市宝山区顾村镇顾村社区卫生服务中心,上海201906 [3]上海市宝山区淞南镇社区卫生服务中心,上海200441

出　　处：《上海预防医学》2021年第10期940-944,共5页Shanghai Journal of Preventive Medicine

基　　金：上海市宝山区科学技术委员会科研项目(16-E-48)。

摘　　要：【目的】分析上海市某镇农村居民脑卒中高危人群中同型半胱氨酸(Hcy)水平与其影响因素的关系,阐明高同型半胱氨酸血症(HHcy)是脑卒中高危因素中主要的生物性指标。【方法】采用整群随机抽样方法,对2018年上海城郊罗泾社区卫生服务中心4073名55岁及以上农村居民进行问卷调查和体格检查,筛查出脑卒中高危对象470名,并测定其血浆Hcy水平及各项血液指标,分析脑卒中高危对象Hcy水平及HHcy患病状况。采用非条件logistic回归分析筛选HHcy相关危险因素。【结果】脑卒中高危对象中Hcy总体水平为(18.92±6.37)μmol/L,男性Hcy水平为(20.40±5.89)μmol/L,高于女性的(17.87±2.12)μmol/L,差异有统计学意义(t=5.431,P<0.001)。HHcy的总检出率为78.94%(371/470),男性HHcy检出率为85.77%(235/274),女性HHcy检出率为69.39%(136/196),差异有统计学意义(χ^(2)=12.400,P<0.001)。男性高危人群中,有吸烟史、超重或肥胖、锻炼频率<1 h/d和有高血压者的HHcy检出率高于无吸烟史、体重指数正常、锻炼频率≥1 h/d和无高血压者,差异有统计学意义(χ^(2)=11.340、8.170、8.200、12.400,均P<0.01),而不同年龄、有无糖尿病和血脂异常者HHcy检出率差异无统计学意义(χ^(2)=3.120、2.311、0.984,均P>0.05)。女性高危人群中,HHcy检出率随年龄增长而升高(χ^(2)=13.874,P<0.01),超重或肥胖、锻炼频率<1 h/d、有高血压和血脂异常者的HHcy检出率高于体重指数正常、锻炼频率≥1 h/d、无高血压和血脂异常者,差异有统计学意义(χ^(2)=10.278、13.840、14.100、12.330,均P<0.01)。非条件因素logistic回归分析显示,脑卒中高危人群中影响HHcy血症的因素有男性、吸烟、高血压及超重和肥胖。【结论】高血压、男性人群为社区脑卒中预防的重点对象,建议将Hcy水平检测纳入脑卒中高危人群筛查。[Objective]To determine the blood level of homocysteine(Hcy)and its influencing factors among Shanghai rural residents with high risk of stroke and to verify if hyperhomocysteinemia(HHcy)is a main biomarker of stroke.[Methods]With a clustered random sampling method,questionnaire survey and physical examination were conducted among 4073 rural residents,aged 55 years and above,in Luojing community,Shanghai,in 2018.A total of 470 residents were at high-risk for stroke based on screening of plasma Hcy and other blood indicators.Multivariate logistic regression method was performed for data analysis.[Results]The overall level of Hcy was(18.92±6.37)μmol/L,with(20.40±5.89)μmol/L for men and(17.87±2.12)μmol/L for women(t=5.431,P<0.001).HHcy was detected in 78.94%(371/470)of the participants,in which 85.77%(235/274)were men and 69.39%(136/196)were women(χ^(2)=12.400,P=0.001).In the high-risk male group,subjects with smoking history,overweight or obesity,exercise frequency<1 h/d,and hypertension has a higher detection rate of HHcy than those without smoking history,normal body mass index,exercise frequency≥1 h/d and without hypertension(χ^(2)=11.340,8.170,8.200,and 12.400,respectively,all P<0.01).However,there was no significant difference in HHcy detection rate in different age groups and between the patients with or without diabetes,and dyslipidemia(χ^(2)=3.120,2.311,and 0.984,respectively,all P>0.05).In the high-risk women group,HHcy detection rate increased with age(χ^(2)=13.874,P<0.01),and it was higher in participants with overweight or obesity,exercise frequency<1 h/d,hypertension,and dyslipidemia(χ^(2)=10.278,13.840,14.100,and 12.330,respectively,all P<0.01).Unconditional logistic regression analysis showed that the factors affecting HHcy in the high-risk population of stroke include being male,smoking,hypertension,overweight and obesity.[Conclusion]Screening of high-risk populations for stroke should include blood level of Hcy.

关 键 词：农村居民 脑卒中高危人群 同型半胱氨酸 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]