心脑血管疾病与同型半胱氨酸临床干预关系的Meta分析

The relationship between cardiovascular and cerebrovascular diseases and the clinical intervention of homocysteine:a Meta-analysis

目的评价临床干预降低心脑血管疾病患者或伴高血浆同型半胱氨酸(homocysteine,HCY)人群的HCY水平对预防心脑血管疾病的作用。方法以"心脑血管疾病"、"同型半胱氨酸"、"干预"、"cardiovascular disease"、"homocysteine"、"HCY"等为检索词,检索CNKI、CBM、Pubmed、OVID等数据库,采用RevMan 5.3软件进行Meta分析。结果共纳入15篇随机对照试验(共45 611例)。试验组与对照组之间心脑血管疾病发生、卒中再发差异均有统计学意义。各亚组心脑血管疾病(0<x≤24、24<x≤48和48<x≤72个月)的OR值(95%CI)分别为0.390(0.260~0.600)、0.980(0.840~1.160)、0.840(0.730~0.970);各亚组卒中再发的OR值(95%CI)分别为0.780(0.620~0.990)、0.320(0.210~0.480)。结论干预HCY时合理控制干预时间(即选择0<x≤24、48<x≤72个月可以达到防治心脑血管疾病的目的;应用叶酸、维生素B12、维生素B6干预均有防治卒中的作用。故推荐将干预HCY作为心脑血管疾病的二级预防措施。

Objective To evaluate the effect of clinical intervention on reducing homocysteine(HCY)levels in patients with cardiovascular and cerebrovascular diseases or with high HCY,and to prevent cardiovascular and cerebrovascular diseases.Methods CNKI,CBM,Pubmed,OVID and other databases were retrieved by 'heart and cerebrovascular disease','homocysteine','HCY','intervention','cardiovascular disease'and 'homocysteine'.RevMan 5.3 software was used for Meta-analysis.Results A total of 15 randomized controlled trials(45 611 patients)were included.According to the results of Meta-analysis,the difference of cardiovascular and cerebrovascular disease or stroke between the experimental and the control group was statistically significant.For the occurrence of cardiovascular and cerebrovascular disease(0<x≤24,24<x≤48 and 48<x≤72 months),the pooled OR(95% CI)were 0.390(0.260-0.600),0.980(0.840-1.160),0.840(0.730-0.970)in subgroups.For the relapse of stroke,the pooled OR(95% CI)were 0.780(0.620-0.990),0.320(0.210-0.480)in subgroups were divided according to the treatment plan.Conclusion It has a protective effect on cardiovascular disease if control the intervention time(0<x≤24 and 48<x≤72 months)when interfering with the level of HCY.Folic acid,Vitamin B12 and Vitamin B6 have preventive and therapeutic effects on the occurrence and relapse of stroke.It is suggested that the intervention HCY as secondary prevention measures for cardiovascular and cerebrovascular diseases.