高同型半胱氨酸血症与急性脑梗死预后的相关性

Correlation between hyperhomocysteinemia and the prognosis in acute cerebral infarction

目的:高同型半胱氨酸血症与急性脑梗死的发生、发展密切相关,本研究探讨高同型半胱氨酸血症与急性脑梗死患者预后的关系。方法:回顾性分析上海中医药大学附属普陀医院2021年10月至2023年2月符合纳入和排除标准的急性脑梗死患者,根据改良Rankin量表(modified Rankin Scale,mRS)评估患者发病3个月后的预后情况,mRS≤2分为预后良好,mRS>2分为预后不良,将预后良好组与预后不良组患者进行单因素分析,选择单因素分析时有统计学意义的因素进一步行受试者操作特征(receiver operator characteristic,ROC)曲线分析和多因素logistic回归分析,判断各因素对预后的诊断价值,确定预后的独立影响因素。结果:共收集病例220例,其中预后良好组126例,预后不良组94例。2组糖尿病(χ2=9.881,P=0.002)、既往卒中或短暂性脑缺血发作史(χ^(2)=5.113,P=0.024)、高同型半胱氨酸血症(χ^(2)=5.611,P=0.018)、血糖(t=-2.577,P=0.011)、同型半胱氨酸(t=-2.694,P=0.008),美国国立卫生研究院量表(National Institutes of Health Stroke Scale,NIHSS)评分(Z=-5.791,P<0.001)差异均有统计学意义。同型半胱氨酸预测急性脑梗死预后具有一定的诊断价值,其最佳截断值为17.205μmol/L,约登指数为0.286,敏感度为72.3%,特异度为56.3%。多因素logistic回归分析显示:高同型半胱氨酸血症(OR=2.154,95%CI 1.107~4.192)、糖尿病(OR=2.632,95%CI 1.307~5.301)、高NIHSS评分(OR=1.395,95%CI 1.245~1.564)为急性脑梗死预后不良的独立危险因素。结论:高同型半胱氨酸血症是急性脑梗死预后不良的独立危险因素。

Objective:Hyperhomocysteinemia is closely related to the occurrence and development of acute cerebral infarction.This study explores the relationship between hyperhomocysteinemia and the prognosis of patients with acute cerebral infarction.Methods:Patients with acute cerebral infarction who met the criteria in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,from October 2021 to February 2023 were retrospectively analyzed.The modified Rankin Scale(mRS)was used to evaluate the prognosis of patients 3 months after the onset.An mRS score of≤2 was defined as a good prognosis,while an mRS score of>2 was defined as a poor prognosis.Univariate analysis was used to analyze the factors associated with prognosis.Factors showing statistical significance in univariate analysis were further analyzed using receiver operator characteristic(ROC)curve analysis and multivariate logistic regression analysis to determine their diagnostic value for prognosis and identify independent influencing factors for prognosis.Results:A total of 220 cases were collected,including 126 cases in the good prognosis group and 94 cases in the poor prognosis group.There were statistically significant differences between the 2 groups in terms of diabetes(χ^(2)=9.881,P=0.002),history of previous stroke or transient ischemic attack(χ^(2)=5.113,P=0.024),hyperhomocysteinemia(χ^(2)=5.611,P=0.018),blood glucose(t=−2.577,P=0.011),homocysteine(t=−2.694,P=0.008),and National Institutes of Health Stroke Scale(NIHSS)score(Z=−5.791,P<0.001).Homocysteinemia had diagnostic value for predicting the prognosis of ischemic stroke,with the optimal cut-off value of 17.205μmol/L,a Youden index of 0.286,sensitivity of 72.3%,and specificity of 56.3%.Multivariate logistic regression analysis showed that hyperhomocysteinemia(OR=2.154,95%CI 1.107 to 4.192),diabetes(OR=2.632,95%CI 1.307 to 5.301),and high NIHSS score(OR=1.395,95%CI 1.245 to 1.564)were independent risk factors for poor prognosis in acute cerebral infarction.Conclusion:Hyperhomocysteinemia is an independent risk factor for poor prognosis in patients with acute cerebral infarction.