抗缪勒氏管激素与缺血性脑卒中关联的病例对照研究

A case-control study of the association between anti-Müllerian hormone and ischemic stroke

目的探讨血浆抗缪勒氏管激素(AMH)水平与缺血性脑卒中的关系。方法病例对照研究,随机抽取江苏省常熟市2018—2019年开展的代谢综合征防治研究中的93例缺血性脑卒中患者作为病例组,按1∶4配对原则选择372例非缺血性脑卒中患者作为对照组,采用酶联免疫吸附试验检测研究对象的血浆AMH水平。采用条件Logistic回归模型和限制性立方样条分析AMH水平与缺血性脑卒中的关系。结果共纳入465例研究对象,年龄(68.7±7.4)岁,其中男性215例(46.2%),女性250例(53.8%)。条件Logistic回归分析结果显示,多因素调整后,总人群Log-AMH水平每升高1个单位,缺血性脑卒中的风险降低44%(OR=0.56,95%CI:0.37~0.85)。与AMH最低分位组相比,最高分位组缺血性脑卒中的患病风险降低(OR=0.37,95%CI:0.19~0.69)。在男性和女性人群中,以AMH水平最低分位组为参照,最高分位组缺血性脑卒中的风险分别降低66%(OR=0.34,95%CI:0.13~0.88)和64%(OR=0.36,95%CI:0.15~0.87)。限制性立方样条分析结果显示,无论是在总人群还是在男性和女性中,血浆AMH水平与缺血性脑卒中呈线性剂量反应关系(线性趋势检验P值分别为0.0002、0.008和0.007)。结论较高浓度的血浆AMH水平可以降低缺血性脑卒中的患病风险,并且存在剂量反应关系。

Objective To investigate the association between plasma anti-Müllerian hormone(AMH)levels and ischemic stroke.MethodsIn this case-control study,93 ischemic stroke patients were randomly selected as the case group from a study on the prevention and treatment of metabolic syndrome,which was conducted in 2018-2019 in Changshu,Jiangsu Province,while 372 nonischemic stroke patients were selected as the control group according to the principle of 1∶4 matching.An enzyme-linked immunosorbent assay was used to measure plasma AMH levels.The conditional logistic regression model and restricted cubic spline were used to analyze the relationship between AMH levels and ischemic stroke.ResultsA total of 465 subjects with an average age of(68.7±7.4)years were included in this study,of whom 215(46.2%)were men and 250(53.8%)were women.According to our conditional Logistic regression analysis,the risk of ischemic stroke was reduced by 44%for every unit increase in the log-AMH level(OR=0.56,95%CI:0.37-0.85)in the overall population after multivariate adjustment.Compared with the tertile with the lowest AMH level,the risk of ischemic stroke in the tertile with the highest AMH level decreased significantly(OR=0.37,95%CI:0.19-0.69).When subgrouped by sex,the tertiles with the highest AMH levels were associated with a 66%lower risk of ischemic stroke in men(OR=0.34,95%CI:0.13-0.88)and a 64%lower risk of ischemic stroke in women(OR=0.36,95%CI:0.15-0.87),compared with the tertiles with the lowest AMH levels.The results of restricted cubic spline analysis showed that there was a linear dose-response relationship between plasma AMH levels and ischemic stroke both in the general population and in male or female population(Pvalues for linear trends were 0.0002,0.008 and 0.007,respectively).ConclusionsHigher plasma AMH levels decrease the risk of ischemic stroke with a dose-response pattern.