血清同型半胱氨酸对冠状动脉粥样硬化性心脏病患者脑卒中发病的影响

Association of serum homocysteine level with stroke in pafients with coronary heart disease

目的探讨血清同型半胱氨酸(Hcy)水平对冠状动脉粥样硬化性心脏病(以下简称冠心病)患者脑卒中发病的影响,为临床研究提供参考依据。方法回顾性收集130例冠心病合并脑卒中的患者作为观察组,同期纳入145例仅有冠心病的患者作为对照组。抽取空腹肘正中静脉血2 ml检测血清Hcy,分析血清Hcy水平对冠心病患者脑卒中发病的影响。结果观察组糖尿病史、高血压病史、吸烟史、体重指数≥25 kg/m^2、冠心病年限患者多于对照组,Hcy及低密度脂蛋白胆固醇(LDL-C)水平明显高于对照组,差异有统计学意义(P<0.05)。多因素分析显示,糖尿病史、高血压病史、吸烟史、Hcy及LDL-C水平增高是冠心病患者脑卒中发生的高危因素(P<0.05)。冠心病患者中Hcy四分位水平最高组(>15.77μg/ml)发生脑卒中的风险是最低组(<10.33μg/ml)的1.84倍(P=0.024),校正相关危险因素后,发生风险仍存在,OR^为1.74倍(P=0.045)。结论血清Hcy水平升高是冠心病患者脑卒中发生的高危因素,且随血清Hcy水平升高其发生风险进一步增加。

Objective To study the association of serum homocysteine （Hcy） level with stroke in coronary heart disease patients. Methods In this study, 130 patients with coronary heart disease and stroke were in- cluded as observation group, and 145 patients with coronary heart disease were included as control group. The serum Hey level was detected and its association with stroke in coronary heart disease patients was ana- lyzed. Results The diabetes history, hypertension history, smoking history, BMI ≥ 25 kg/m^2, years of coronary heart disease, Hcy level and LDL-C level in the observation group were significantly higher than those in the control group （P〈0.05）. Multivariate analysis showed that diabetes history, hypertension history, smoking history, increased Hcy and LDL-C levels were the risk factors of cerebral stroke in the patients with coronary heart disease （P〈 0.05）. The subjects with Hey level in the highest quartile （〉15.77 μg/ml） had 84% higher risk to develop stroke compared with those whose Hey level was within the lowest quartile （〈 10.33 μg/ml） with sig- nificant difference （P= 0.024）; even after correction of the related risk factors, the risk rate was 74% higher （P= 0.045）. Conclusions Elevated serum Hcy level is the high risk factor of cerebral stroke in patients with coro- nary heart disease. With the elevation of serum Hcy level, the risk further increases.