天津市834名社区脑卒中高危人群血清同型半胱氨酸水平及相关危险因素分析

Analysis of the serum homocysteine levels and the relevant risk factors of stroke on 834 high-risk community residents in Tianjin

目的 了解天津市河北区及东丽区40岁以上脑卒中高危人群危险因素、暴露水平及其人群分布特征,探讨脑卒中高危人群血清同型半胱氨酸（Hcy）水平及其影响因素.方法 纳入脑卒中高危人群834名,按年龄将其分为A组（40～49岁）、B组（50～59岁）、C组（60～69岁）和D组（≥70岁）.通过方差分析、χ2检验及二元logistic回归分析对数据进行分析.结果 A组血清Hcy水平为（12.25±4.54）μmol/L,B组为（14.01±6.67） μmol/L,C组为（15.76±8.88） μmol/L,D组为（18.21±8.99）μmol/L,随着年龄增长血清Hcy水平也随之升高（F=15.476,P＜0.05）.男性高同型半胱氨酸血症（HHcy）比例高于女性（χ2=31.034,P＜0.05）.既往脑卒中史及吸烟者HHcy比例高于非暴露者（χ2=9.888和18.486,P均＜0.05）;短暂性脑缺血发作、心脏病、高血压、血脂异常及缺乏体育锻炼者HHcy比例与非暴露者比较差异无统计学意义（χ2=0.688、0.773、2.042、1.427和0.560,P均＞0.05）;而糖尿病者HHcy比例低于非暴露者（χ2=30.345,P＜0.05）.logistic 回归分析得到HHcy的独立危险因素包括男性（OR=2.332）、吸烟（OR=1.537）及既往脑卒中史（OR=1.946）.结论 血清Hcy检测在脑卒中高危人群筛查中有重要价值,HHcy是脑卒中的独立危险因素之一.应对脑卒中高危人群进行科学的指导干预以降低脑卒中的发生率.

Objective To identify the risk factors, level of exposure, and the population distribution in high-risk stroke people groups with age over 40 years in Hebei and Dongli Districts of Tianjin.To explore the level of serum homocystenine （Hcy） and its influencing factors.Methods A total of 834 high-risk cases were accepted and divided into groups A （40～49）, B （50～59）, C （60～69）, and D （≥ 70） based on age.Data were analyzed using ANOVA, Chi-square test, and binary logistic regression.Results The serum Hcy values were （12.25 ±4.54）, （14.01 ±6.67）, （15.76±8.88）, and （18.21 ±8.99） μmol/L for groups A to D, respectively.The level of serum Hcy increased with increasing age （F=15.476, P〈0.05）.The rate of males with hyperhomocysteinemia（HHcy） was significantly higher than that of females（χ2=31.034, P〈0.05）.The rates in the exposed group with previous stroke history and smoking were significantly higher than those of the non-exposed group（χ2=9.888 and 18.486, both P〈0.05）.The rates in exposed group with transient ischemic attack （TIA）, heart disease, high blood pressure, dyslipidemia, and lack of physical exercise showed no significant difference with the non-exposed group （χ2=0.688, 0.773, 2.042, 1.427 and 0.560, all P〉0.05）, but the rate in exposed group with diabetes was significantly lower than nonexposed group（χ2=30.345, P〈0.05）.The independent risk factors of HHcy were male（OR=2.332）, smoking （OR=1.537）, and previous stroke history （OR=1.946） according to the logistic regression.Conclusions The detection of serum Hcy is extremely important in screening high-risk populations for stroke.HHcy is an independent risk factor of stroke.It＇ s important to take measures to reduce the incidence of stroke.