高同型半胱氨酸对合并非瓣膜性心房颤动的急性脑梗死患者近期预后的影响

Impact of Hyperhomocysteine on Short-Term Outcome in Acute Cerebral Infarction Patients with Non-Valvular Atrial Fibrillation

目的探讨同型半胱氨酸(homocysteine,Hcy)对合并非瓣膜性心房颤动的急性脑梗死患者近期预后的影响。方法前瞻性连续纳入合并非瓣膜性心房颤动的急性脑梗死的住院患者,所有患者均在发病48 h内住院。收集患者的基线临床资料及相关实验室检查结果。随访患者发病90 d时临床预后,良好预后定义为mRS评分≤2分。采用多因素Logistic回归分析,探讨合并非瓣膜性心房颤动的急性脑梗死患者90 d预后的独立影响因素。结果共纳入患者112例,男性46例(41.1%),年龄45~92岁,平均76.23±9.02岁。其中良好预后患者53例(47.3%)。多因素回归分析显示,入院时NIHSS评分高(OR 1.632,95%CI 1.185~2.250,P=0.03)、高血糖(OR 1.360,95%CI 1.052~1.758,P=0.019)、高Hcy水平(OR 1.702,95%CI 1.133~2.557,P=0.010)是影响患者90 d预后的独立危险因素。结论高Hcy是合并非瓣膜性心房颤动的急性脑梗死患者短期不良预后的独立影响因素。

Objective To explore the impact of hyperhomocysteine on short-term outcome in acute cerebral infarction(ACI)patients with non-valvular atrial fibrillation(AF).Methods This prospective study consecutively enrolled ACI inpatients within 48 hours of stroke onset and with no-valvular AF.Baseline clinical data and relevant laboratory test results were collected.The primary outcome was a mRS score at 90 days.Good outcome was defined as a mRS score of 0-2.Multivariate logistic regression analysis was performed to determine the independent risk factors for 90-day outcome.Results A total of 112 patients were included,with 46 males(41.4%)and a mean age of 76.23±9.02 years old(range:45-92 years old).53(47.3%)patients had good prognosis.Multivariate logistic regression analysis showed that higher NIHSS score at admission(OR 1.632,95%CI 1.185-2.250,P=0.03),hyperglycemia(OR 1.360,95%CI 1.052-1.758,P=0.019)and higher homocysteine(OR 1.702,95%CI 1.133-2.557,P=0.010)were independent risk factors for 90-day clinical outcome.Conclusions Hyperhomocysteine may be an independent risk factor for 90-day outcome in ACI patients with non-valvular AF.