40岁及以上人群同型半胱氨酸与脑卒中的关系研究  

Correlation Analysis of Homocysteine and Stroke in People over 40 Years Old

作　　者：李玫 蒋东升[1] 赵晶晶 曹亚景[1] 张帆[1] 唐丽娟[1] 刘晓丽[1] LI Mei;JIANG Dongsheng;ZHAO Jingjing;CAO Yajing;ZHANG Fan;TANG Lijuan;LIU Xiaoli(Institute of Chronic Non-communicable Diseases,Hebei Province Center for Disease Prevention and Control,Shijiazhuang 050021,China)

机构地区：[1]河北省疾病预防控制中心慢性非传染性疾病防治所,河北省石家庄市050021

出　　处：《中国全科医学》2025年第14期1723-1729,共7页Chinese General Practice

基　　金：河北省医学科学研究课题计划(20210354)。

摘　　要：背景同型半胱氨酸(Hcy)水平与脑卒中等血管健康问题紧密相关,早期识别与筛查高同型半胱氨酸血症(HHcy)对预防脑卒中至关重要。而河北地区缺少Hcy与脑卒中关系的系统性流行病学数据,且HHcy与其他风险因素的综合作用研究不足,限制了有效防控策略的制定。目的探讨河北省40岁及以上人群Hcy与脑卒中的关系,旨在为制订精准的脑卒中防控策略提供科学依据。方法本研究在2018—2020年中国脑卒中筛查项目基础上,采用多阶段整群抽样方法,在河北省9市49个监测点抽取40岁及以上常住人口92942人。采用非条件Logistic回归分析的方法探讨Hcy与脑卒中的相关性,并进行年龄、性别分层分析。同时,进一步研究Hcy与其他因素结合对脑卒中影响的综合效应。结果河北省40岁及以上人群脑卒中患病率为4.51%(4196/92942),高Hcy发生率为36.25%(33692/92942)。高Hcy水平人群脑卒中患病率高于正常Hcy水平人群(P<0.05);将Hcy按照四分位数进行划分,随着Hcy水平的逐渐升高,脑卒中患病率呈递增趋势(χ^(2)_(趋势)=367.310,P<0.05)。分层分析结果显示:在两个年龄段中(40~59岁、≥60岁),高Hcy水平人群脑卒中患病率高于正常Hcy水平人群(P<0.05);随着Hcy水平从Q1递增至Q4,40~59岁、≥60岁人群脑卒中患病率均呈递增趋势(χ^(2)_(趋势)值分别为109.213、75.653,P<0.05)。不同性别人群中高Hcy水平脑卒中患病率均高于正常Hcy水平(P<0.05);且随着Hcy水平从Q1递增至Q4,男性和女性人群脑卒中患病率均呈递增趋势(χ^(2)_(趋势)值分别为197.115、117.406,P<0.05)。高Hcy与高血压有正向相加交互作用(RERI=0.41,AP=0.08,SI=1.12,P<0.05)但无相乘交互作用;高Hcy与吸烟有负向相加(RERI=-0.30,AP=-0.25,SI=0.41,P<0.05)和负向相乘(OR=0.77,95%CI=0.64~0.92,P<0.05)交互作用;未发现与糖尿病、饮酒存在交互作用。结论河北省40岁及以上人群高Hcy患病率超过36%,且随着Hcy水平升�Background Homocysteine(Hcy)levels are strongly associated with vascular health problems like stroke,and early identification and screening for hyperhomocysteinemia(HHcy)is crucial for stroke prevention.However,lack of systematic epidemiological data on the relationship between Hcy and stroke in Hebei Province,China,and insufficient comprehensive studies on HHcy and other risk factors limit the development of effective prevention and control strategies.Objective To investigate the correlation between Hcy and stroke in people aged 40 years and over in Hebei Province,thus providing scientific basis for the development of accurate stroke prevention and control strategies.Methods On the basis of the China National Stroke Screening Survey from January 2018 to December 2020,92942 permanent residents aged 40 and above were sampled from 49 monitoring sites in 9 cities of Hebei Province by multi-stage cluster sampling method.The correlation between Hcy and stroke was investigated by unconditional Logistic regression analysis,and stratified analysis was performed based on age and sex.At the same time,the combined effects of Hcy and other factors on stroke were further studied.Results The prevalence of stroke among people aged 40 years and above in Hebei Province was 4.51%(4196/92942),and the prevalence of high Hcy was 36.25%(33692/92942).The prevalence of stroke in people with high Hcy levels was significantly higher than that in people with normal Hcy levels(P<0.05).Stratified by Hcy quartiles,the prevalence of stroke tended to increase as Hcy 2 levels gradually increased(χ^(2)_(trend)=367.310,P<0.05).The results of stratification analysis showed that in two age groups(40-59 years old and≥60 years old),the prevalence of stroke was significantly higher in people with high Hcy levels than in people with normal Hcy levels(P<0.05).With the incremental increase of Hcy levels from Q1 to Q4,the prevalence of stroke in people 2 with 40-59 and≥60 years old showed an incremental trend(the trendχ^(2)values were 109.213,and 75.

关 键 词：脑卒中 同型半胱氨酸 相关性 联合作用 交互作用 河北省 

分 类 号：R743[医药卫生—神经病学与精神病学]