高血压患者同型半胱氨酸与卒中关系的前瞻性研究

A prospective study on the association of plasma homocysteine level with stroke in hypertensive patients

目的 揭示高血压患者同型半胱氨酸（Hcy）与卒中的关系.方法 采用前瞻性队列研究设计,对深圳市南山区60个社区的5 488例高血压患者进行基线调查和平均2.7年随访.Hcy采用循环酶法检测,卒中包括ICD-10编码中I60-I64的类型,根据患者的院前症状、头颅CT、头颅MRI、脑血管造影和经颅多普勒超声等检查结果进行确诊.结果 5 488例高血压人群327例失访,失访率5.96％,新发卒中患者197例,累积发病率3.82％.在矫正年龄、性别、教育、吸烟、饮酒、BMI、体育锻炼、糖尿病、抑郁、卒中家族史、患病年限、降压药、叶酸、收缩压、TC、血糖和TG后,Hcy最高四分位数（Q4）与最低四分位数（Q1）相比,Hcy引发卒中的HR为7.4（3.2 ～13.2）,其中男性7.5（3.0 ～19.5）,女性7.7（2.7 ～22.1）.Hcy每增加5μmol/L引发卒中的HR为1.15（1.09 ～1.21）,其中男性和女性分别为1.15（1.08～1.21）和1.19（1.04～1.35）;未发现Hcy与心脑血管疾病传统危险因素对卒中具有交互作用.结论 高血压患者中Hcy水平和卒中可能具有正相关的关系.

Objective To analyze the association between homocysteine （Hcy） and stroke in hypertensive patients.Methods This was a prospective cohort study conducted in 60 communities in Nanshan District,Shenzhen.Totally 5 488 patients with hypertension were included at baseline survey and followed for an average of 2.7 years.At the end of follow-up,327 （5.96%） subjects were missing with unknown reasons.Hcy was detected by enzymatic cycling method.Head CT,MRI,cerebral angiography and transcranial Doppler ultrasound were performed in the patients.Stroke was defined based on the International Classification of Diseases （ICD10 coding I60-I64）.Results After an average of 2.7-year follow-up,197 developed new stroke.The incidence rate was 3.82%.Subjects whose Hcy levels were within the highest quartile （Q4） had higher risk to develop stroke compared with those whose Hey levels were within the lowest quartile （Q1）.The HR （95% CI） were 7.4 （3.2-13.2） in total with 7.5 （3.0-19.5） in men and 7.7（2.7-22.1） in women after adjustment of age,sex,education,smoking,alcohol drinking,and BMI,physical activity,diabetes,depression,family history of stroke or coronary heart disease,years of hypertension,antihypertensive drugs,folic acid,systolic blood pressure,TC,glucose and TG.For every 5 μmol/L increase in Hcy,the HR （95% CI） of stroke increased 1.15-fold （1.09-1.21） in total subjects with 1.15（1.08-1.21） in men and 1.19（1.04-1.35） in women,respectively.No significant interactions on stroke could be found between Hcy and the above stratified factors.Conclusion Elevated Hcy levels were associated with stroke in hypertensive patients.