同型半胱氨酸对高血压患者脑卒中复发风险的影响

目的探讨高血压合并脑卒中患者的血浆同型半胱氨酸（Hcy）水平与其他危险因素对于脑卒中复发的影响。 方法分析徐州市中心医院心内科和徐州医科大学附属医院神经外科自2012年5月至2013年12月收治的1623例高血压脑卒中患者的基线资料，中位随访4.9年，根据随访事件中是否发生脑卒中分为复发组（312例）与未复发组（1311例）。Kaplan-Meier生存分析比较不同危险因素脑卒中复发率的差异，单因素与多因素Cox回归模型分析影响脑卒中复发的独立危险因素，以及危险因素之间的交互作用。 结果复发组年龄、空腹血糖、Lg Hcy的水平，以及糖尿病、房颤的患病率均高于未复发组（P<0.05）。Kaplan-Meier生存分析显示，糖尿病、房颤、年龄≥60岁、空腹血糖≥7.0 mmol/L、Hcy≥15 μmol/L的脑卒中复发率明显升高（Log-rank检验，P<0.05）。多因素Cox回归模型分析显示，高龄、Lg Hcy水平升高，以及房颤、糖尿病是脑卒中复发的独立危险因素。Lg Hcy分别与糖尿病、空腹血糖、年龄存在交互作用。 结论血浆Hcy水平升高既是高血压合并脑卒中患者卒中复发的独立危险因素，又通过与糖尿病、高龄、空腹血糖水平升高的交互作用显著增加脑卒中复发风险。

Homocysteine for the risk of recurrent stroke in patients with stroke and hypertension

ObjectiveTo explore both homocysteine (Hcy) and other risk factors for the recurrent stroke in patients with stroke and hypertension. MethodsA total of 1623 hospitalized patients with stroke and hypertension recruited from Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University and Department of Cardiology, Xuzhou Central Hospital were analyzed. During a median follow-up period of 4.9 years, patients were divided into the recurrence group with 312 patients and the non-recurrence group with 1311 patients according to achieved follow-up recurrent stroke. The Kaplan-Meier method was used to estimate the cumulative incidences of recurrent stroke among subgroups. Independent risk factors and their interactions with recurrent stroke were identified by uni- and multi-variate Cox regression analysis with the baseline clinical characteristics. ResultsCompared with the non-recurrence group, patients in the recurrence group were older with higher level of fasting plasma glucose and Lg Hcy, and higher proportion of previous history of diabetes mellitus and atrial fibrillation (P<0.05). Subgroup analysis showed patients with diabetes mellitus, atrial fibrillation, age ≥60 years fasting plasma glucose ≥7.0 mmol/L, and Hcy ≥15 μmol/L have a higher incidence of recurrence than other groups. Multi-variate Cox regression analysis showed that older patients, elevated Lg Hcy levels, diabetes mellitus and atrial fibrillation were independent risk factors for recurrent stroke in patients with stroke and hypertension. Furthermore, the interactions between Lg Hcy and other risk factors were statistically significant: diabetes mellitus, fasting plasma glucose and age. ConclusionHcy is not only an independent risk factor, but also interactions with other risk factors on recurrent stroke in patients with stroke and hypertension.