脑小血管病患者幽门螺杆菌感染与同型半胱氨酸水平的研究

Correlation between Helicobacter pylori infection and homocysteine levels and cerebral small vessel disease

目的研究幽门螺杆菌(Helicobacter pylori,HP)感染和同型半胱氨酸(homocysteine,Hcy)水平与脑小血管病(cerebral small vessel disease,CSVD)的相关性。方法选取2017年3月至2018年12月锦州医科大学附属第一医院主诉头晕的门诊及住院患者67例,按照是否存在CSVD分为CSVD组(30例)及对照组(37例),应用单因素分析、Spearman相关分析、二元Logistic回归分析分析CSVD的独立影响因素;应用ROC曲线预测相关影响因素对CSVD的诊断价值;应用中介效应分析判断HP、Hcy对CSVD的影响效应。结果(1)CSVD与Hcy(r=0.345,P=0.004)、HP阳性(r=0.274,P=0.026)、年龄(r=0.420,P=0.000)、性别(r=0.260,P=0.034)、总胆固醇(r=0.273,P=0.025)、甘油三酯(r=0.272,P=0.026)、高血压(r=0.454,P=0.000)、糖尿病(r=0.284,P=0.020)、吸烟(r=0.499,P=0.000)、冠心病(r=0.284,P=0.020)呈正相关;(2)Logistic回归分析显示,Hcy(β=0.315,OR=1.370,95%CI=1.025~1.831)、总胆固醇(β=0.979,OR=2.661,95%CI=1.086~6.523)是CSVD的独立危险因素;(3)Hcy(敏感度=76.7%,特异性=86.5%)及总胆固醇水平(敏感度为90.0%,特异性为83.8%)对于诊断CSVD具有特异且敏感的诊断价值,并且总胆固醇(ROC曲线下面积=0.928)相比Hcy(ROC曲线下面积=0.877)更具有诊断价值;(4)HP对CSVD的中介效应不完全通过中介变量Hcy的中介作用来影响,HP对CSVD有部分直接效应。结论(1)Hcy及总胆固醇是CSVD的独立危险因素,对于CSVD具有特异且敏感的诊断价值,其中总胆固醇的诊断价值更大;(2)HP阳性对CSVD的中介效应不完全通过中介变量Hcy的中介作用来影响,HP对CSVD有部分直接效应。

Objective To study the relationship between Helicobacter pylori(HP)infection and homocysteine(Hcy)levels and cerebral small vessel disease(CSVD).Methods From March 2017 to December 2018,67 patients(outpatient and inpatient)who complained of dizziness in the First Affiliated Hospital of Jinzhou Medical University were divided into CSVD group(30 cases)and control group(37 cases).Single factor analysis,Spearman correlation analysis and binary logistic regression analysis were used to analyze the influencing factors of CSVD.Receiver operating characteristic curve was used to predict the diagnostic value of influencing factors for CSVD.The effects of HP and Hcy on CSVD were analyzed using mediation effect.Results(1)Hcy(r=0.345,P=0.004),HP positive(r=0.274,P=0.026),age(r=0.420,P=0.000),male(r=0.260,P=0.034),total cholesterol(r=0.273,P=0.025),triglycerides(r=0.272,P=0.026),hypertension(r=0.454,P=0.000),diabetes(r=0.284,P=0.020),smoking(r=0.499,P=0.000),coronary heart disease(r=0.284,P=0.020)were positively correlated with CSVD.(2)Logistic regression analysis showed that Hcy(β=0.315,OR=1.370,95%CI=1.025-1.831),total cholesterol(β=0.979,OR=2.661,95%CI=1.086-6.523)were independent risk factors for CSVD.(3)Hcy(sensitivity:76.7%,specificity:86.5%)and total cholesterol levels(sensitivity:90.0%,specificity:83.8%)had specific and sensitive diagnostic value for the diagnosis of CSVD,and total cholesterol(area under ROC curve=0.928)had more diagnostic value than Hcy(area under ROC curve=0.877).(4)The mediating effect of HP on CSVD was not completely affected by the mediating effect of Hcy,and HP had partially direct effect on CSVD.Conclusions(1)Hcy and total cholesterol are independent risk factors of CSVD,which have specific and sensitive diagnostic value for CSVD,especially for total cholesterol.(2)The mediating effect of HP on CSVD is not completely affected by the mediating variable Hcy,and HP has a partially direct effect on CSVD.