Hhcy对缺血性脑卒中患者再发缺血性血管事件及相关死亡事件的影响

目的探讨高同型半胱氨酸血症(hyperhom ocysteinemia,Hhcy)对缺血性卒中(IS)患者再发、死亡及冠状动脉和外周动脉缺血性事件发生的影响,为进一步对缺血性血管病的综合干预提供依据。方法检测245例IS患者空腹血浆同型半胱氨酸(Hcy)水平,并参照同期选取的52例健康体检者为对照者按血浆Hcy水平将其分为Hhcy组和非Hhcy组,追踪观察两组患者IS再发、死亡及冠状动脉和外周动脉缺血事件的发生情况。结果其中Hhcy组IS再发率(52.63%)显著高于非Hhcy组(24.67%)(P<0.01);死亡事件发生率(12.63%)亦显著高于非Hhcy组(3.33%)(P<0.01);冠脉缺血事件发生率(18.95%)明显高于非Hhcy组(10.00%)(P<0.05);外周动脉缺血事件发生率两组分别为5.26%和2.67%,差异无统计学意义(P>0.05);并发2种以上缺血性事件的患者Hhcy组(17.89%)显著多于非Hhcy组(5.33%)(P<0.01);Hhcy组患者5年内缺血性血管事件发生率(57.89%)显著高于非Hhcy组(32.00%)(P<0.01);Logistic回归分析发现,Hcy升高是IS患者缺血性血管事件再发的独立危险因素(OR分别为1.174;95%CI1.119~1.233;P<0.05)。结论 Hhcy与IS患者缺血性血管事件再发及死亡预后密切相关。

The influence of hyperhomocysteinemia on the recurrent ischemic vascular events and relative death of stroke patients

Objective To explore the possible influence of the hyperhomocysteinemia（Hhcy）on the occurence of recurrent ischemic stroke（IS）,death,coronary and peripheral artery ischemic events in hope for finding some valuable information for the synthetically therapy of ischemic vascular diseases.Methods We determined the free plasma homocysteine（Hcy）of 245 patients with IS and divided them into Hhcy group and non-hyperhomocysteinemia（Nhhcy）group according the plasma Hcy level of 52 homeochronous healthy controls.We follow-up the recurrence of IS and the occurrence of death,coronary and peripheral artery ischemic events in the 2 groups.Results The incidence of recurrent IS of Hhcy group was statistically higher than that of Nhhcy group（52.63% versus 24.67,P0.01）.The mortality of Hhcy group was also statistically higher than that of Nhhcy group（12.63% versus 3.33%,P0.01）,so was the incidence of the coronary ischemic events（18.95% versus 10.00%,P0.05）.The incidence of the peripheral artery ischemic events of Hhcy group was higher than that of Nhhcy group,but the diference was not statistically significant（5.26% versus 2.67%,P0.05）.The proportion of the patients with more than 2 kinds of ischemic events in Hhcy group was statistically higher than that in Nhhcy group（17.89% versus 5.33%,P0.01）.The diference of incidence of all ischemic events between the 2 group was statistically significant（Hhcy ：57.89%;Nhhcy：32.00%;P0.01）.By forward stepwise logistic analysis,we found that the increased Hcy was an independent risk factor of the recurrent ischemic vascular events（OR was 1.174,95%CI was 1.119~1.233;P0.05）.Conclusion Hhcy is correlated with the recurrent ischemic vascular events and death prognosis of ischemic stroke patients.