血清高半胱氨酸与急性缺血性卒中患者早期神经功能恶化的相关性

Correlation between serum homocysteine and early neurological deterioration in patients with acute ischemic stroke

目的探讨血清高半胱氨酸(homocysteine,Hcy)与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性。方法回顾性连续纳入2018年6月至2019年8月期间亳州市人民医院收治的发病24 h内的急性缺血性卒中患者。收集基线临床、影像学和实验室检查资料。END定义为发病72 h内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分或运动项评分增加≥1分。采用单变量分析比较END组和非END组之间的人口统计学、血管危险因素、基线血压、实验室检查指标、卒中病因学分型、卒中分布及发病到入院时间。采用多变量logistic回归分析确定END的独立危险因素。结果共纳入急性缺血性卒中患者112例,其中29例(25.9%)发生END。单变量分析显示,END组与非END组基线NIHSS评分(Z=4.653,P<0.001)、C反应蛋白(C-reactive protein,CRP)(t=2.437,P=0.017)、空腹血糖(t=2.781,P=0.006)、Hcy(t=3.932,P<0.001)和糖化血红蛋白(t=2.107,P=0.047)差异有统计学意义。多变量logistic回归分析显示,高基线NIHSS评分[优势比(odds ratio,OR)1.566,95%可信区间(confidence interval,CI)1.237~1.982;P=0.015]、CRP>10 mg/L(OR 3.138,95%CI 1.871~5.362;P=0.030)、空腹血糖>6.1 mmol/L(OR 2.529,95%CI 1.736~4.651;P=0.027)和Hcy>15μmol/L(OR 3.542,95%CI 1.295~9.461;P=0.038)是急性缺血性卒中患者发生END的独立危险因素。结论基线血清Hcy水平增高是急性缺血性卒中患者发生END的独立危险因素。

Objective To investigate the correlation between the level of serum homocysteine(Hcy)and early neurological deterioration(END)in patients with acute ischemic stroke.Methods From June 2018 to August 2019,consecutive patients with acute ischemic stroke within 24 h of onset admitted to Bozhou People's Hospital were enrolled retrospectively.Their baseline cilinical data,imaging and laboratory findings were collected.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score increased≥2 or the motor item score increased≥1 within 72 h of onset compared with the baseline.Univariate analysis was used to compare the demography,vascular risk factors,baseline blood pressure,laboratory findings,etiological typing of stroke,stroke distribution and the time from onset to admission between the END group and non-END group.Multivariate logistic regression analysis was used to identify the independent risk factors for END.Results A total 112 patients with acute ischemic stroke were enrolled,among them,29(25.9%)occurred END.Univariate analysis showed that there were significant differences in baseline NIHSS score(Z=4.653,P<0.001),C-reactive protein(CRP)(t=2.437,P=0.017),fasting blood glucose(t=2.781,P=0.006),Hcy(t=3.932,P<0.001)and glycated hemoglobin(t=2.107,P=0.047)between the END group and the non-END group.Multivariate logistic regression analysis showed that high baseline NIHSS score(odds ratio[OR]1.566,95%confidence interval[CI]1.237-1.982;P=0.015),CRP>10 mg/L(OR 3.138,95%CI 1.871-5.362;P=0.030),fasting blood glucose>6.1 mmol/L(OR 2.529,95%CI 1.736-4.651;P=0.027),and Hcy>15μmol/L(OR 3.542,95%CI 1.295-9.461;P=0.038)were the independent risk factors for END in patients with acute ischemic stroke.Conclusion The elevated baseline serum Hcy level was an independent risk factor for END in patients with acute ischemic stroke.