[1]梁书锋,栾恒钰,宋玉健,等.同型半胱氨酸和血糖联合检测与脑卒中患病风险的相关性[J].新乡医学院学报,2022,39(10):972-977.[doi:10.7683/xxyxyxb.2022.10.014]
　LIANG Shufeng,LUAN Hengyu,SONG Yujian,et al.Correlation between combined detection of homocysteine and blood glucose and the risk of stroke[J].Journal of Xinxiang Medical University,2022,39(10):972-977.[doi:10.7683/xxyxyxb.2022.10.014]
点击复制

同型半胱氨酸和血糖联合检测与脑卒中患病风险的相关性
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年10
页码:
972-977
栏目:
临床研究
出版日期:
2022-10-05

文章信息/Info

Title:
Correlation between combined detection of homocysteine and blood glucose and the risk of stroke
作者:
梁书锋1; 栾恒钰1; 宋玉健1; 宋丽莎1; 李世铭1; 卢楠2; 衣志勇2; 赛晓勇1
(1.解放军总医院研究生院统计学与流行病教研室,北京　100853;2.中共中央办公厅警卫局卫生保健处,北京　100017)
Author(s):
LIANG Shufeng1; LUAN Hengyu1; SONG Yujian1; SONG Lisha1; LI Shiming1; LU Nan2; YI Zhiyong2; SAI Xiaoyong1
（1.Department of Epidemiology and Statistics,the Graduate School of the Chinese PLA General Hospital,Beijing 100853,China；2.Health Care Division,Security Bureau of Headquarters of the General Staff,Beijing 100017,China）
关键词:
脑卒中; 同型半胱氨酸; 高血糖; 协同作用; 配对分析
Keywords:
stroke; homocysteine; hyperglycemia; synergistic effect; matching analysis
分类号:
R743
DOI:
10.7683/xxyxyxb.2022.10.014
文献标志码:
A
摘要:
目的　探讨同型半胱氨酸和血糖联合检测与脑卒中患病风险的相关性，为脑卒中的早期防治提供循证依据。方法　采用回顾性调查研究方法，选择2007年1月至2012年12月解放军总医院确诊的1 364例脑卒中住院患者为观察组，按年龄、性别、体质量指数（BMI）进行1∶1配对选择同期在本院住院治疗的1 364例单纯腰椎间盘突患者为对照组。通过医疗记录收集2组患者的年龄、性别、病史、家族病史、身高、体质量、血压、血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、同型半胱氨酸和空腹血糖水平等临床特征资料。采用配对χ2检验（McNemar检验）、连续变量的配对t检验和Wilcoxon配对符号秩和检验等比较2组患者各类指标的差异，采用配对logistic回归模型分析方法分析脑卒中患病风险因素。结果　观察组与对照组患者的年龄、性别、BMI及高脂血症家族史比较差异无统计学意义（P>0.05），观察组患者中吸烟、饮酒者占比和有高血压、脑卒中、冠状动脉性心脏病(CAHD)、糖尿病等家族史者占比、有高血压、脑卒中、CAHD、高脂血症、糖尿病既往史者占比以及目前有高血压、血脂异常、血糖以及同型半胱氨酸水平增高者占比均显著高于对照组（P<0.05）。 调整吸烟情况、饮酒史、家族史（高血压、脑卒中、CAHD、高脂血症、糖尿病）、既往史（高血压、脑卒中、CAHD、高脂血症、糖尿病）、是否患有高血压以及血脂异常因素后，空腹血糖水平增高、同型半胱氨酸水平增高与脑卒中的发生相关（P<0.05）。与血糖正常的患者相比较，高血糖患者发生脑卒中的风险增加74.7%（P<0.05）；与正常水平同型半胱氨酸患者相比较，高同型半胱氨酸患者发生脑卒中的风险增加47.4%（P<0.05）。调整吸烟情况、饮酒史、家族史（高血压、脑卒中、CAHD、高脂血症、糖尿病）、既往史（高血压、脑卒中、CAHD、高脂血症、糖尿病）、是否患有高血压以及血脂异常因素后，空腹血糖增高、同型半胱氨酸增高以及空腹血糖和同型半胱氨酸均增高是发生脑卒中的危险风险（P<0.05）。与同型半胱氨酸和空腹血糖水平均正常的患者相比较，仅同型半胱氨酸增高的患者、仅空腹血糖增高的患者发生脑卒中的风险分别增加108.1%（P<0.05）和66.0%（P<0.05），高同型半胱氨酸伴高血糖的患者发生脑卒中的风险增加113.7%（P<0.05）。结论　高同型半胱氨酸和高血糖可能对脑卒中患者具有正向协同作用，高空腹血糖伴高同型半胱氨酸显著增加脑卒中的患病风险。临床防治过程中应控制血糖和同型半胱氨酸水平，以降低脑卒中的发生风险。
Abstract:
Objective　To investigate the correlation between the combine detection of homocysteine and blood glucose and the risk of stroke,and provide evidence based basis for the prevention and treatment of stroke.Methods　A retrospective study design was used.A total of 1 364 stroke patients diagnosed in Chinese PLA General Hospital from January 2007 to December 2012 were selected as the observation group,and 1 364 patients with simple prolapse of lumbar intervertebral disc whose age,gender and body mass index(BMI) were matched with the patients in the observation group(1∶1) were recruited as the control group.The age,sex,medical history,family history,height,body mass,blood pressure,total serum cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,homocysteine and fasting blood glucose level of the patients in the two groups were collected.The differences of various indicators of patients between the two groups were compared by the paired χ2 test (McNemar test),paired t test of continuous variables and Wilcoxon paired sign rank sum test,and the risk factors of stroke was analyzed by the paired logistic regression model.Results　There was no significant difference in age,sex,BMI and family history of hyperlipidemia of patients between the observation group and the control group (P>0.05).The percentage of smokers and drinkers,the percentage of patients with family history of hypertension,stroke,coronary atery heart disease (CAHD),diabetes,the percentage of patients with previous history of hypertension,stroke,CAHD,hyperlipidemia,diabetes,and the percentage of patients with hypertension,dyslipidemia,increased blood glucose and increased homocysteine of patients in the observation group were significantly higher than those in the control group (P<0.05).The high fasting blood glucose and homocysteine level were associated with the occurrence of stroke after adjusting for smoking status,drinking,family history(hypertension,stroke,CAHD,hyperlipidemia,diabetes),previous history (hypertension,stroke,CAHD,hyperlipidemia,diabetes),whether suffering from hypertension and dyslipidemia (P<0.05).Compared with patients with normal blood glucose,the risk of stroke in patients with hyperglycemia increased by 74.7% (P<0.05);Compared with patients with normal level of homocysteine,the risk of stroke in patients with high homocysteine was increased by 47.4% (P<0.05).After adjusting for smoking status,drinking,family history(hypertension,stroke,CAHD,hyperlipidemia,diabetes),previous history(hypertension,stroke,CAHD,hyperlipidemia,diabetes),whether suffering from hypertension and dyslipidemia,the increased fasting blood glucose,homocysteine and both increased fasting blood glucose and homocysteine were risk factors for stroke (P<0.05).Compared with patients with both normal homocysteine and fasting blood glucose,the risk of stroke of patients with elevated homocysteine only and elevated fasting glucose only was increased by 108.1% and 66.0%,respectively (P<0.05);the risk of stroke of patients with hyperhomocysteine and hyperglycemia was increased by 113.7% (P<0.05).Conclusion　Elevated homocysteine and hyperglycemia may have a positive synergistic effect on stroke patients,elevated homocysteine and hyperglycemia enhances the risk of stroke.In the clinical prevention and treatment process,the levels of blood glucose and homocysteine should be controlled in order to reduce the risk of stroke.

参考文献/References:

［1］　GBD 2016 CAUSES OF DEATH COLLABORATORS.Global,regional,and national age-sex specific mortality for 264 causes of death,1980-2016:a systematic analysis for the Global Burden of Disease Study 2016［J］.Lancet,2017,390(10100):1151-1210.
［2］　王陇德，刘建民，杨弋，等.我国脑卒中防治仍面临巨大挑战：《中国脑卒中防治报告2018》概要［J］.中国循环杂志,2019,34(2):105-119.
WANG L D,LIU J M,YANG Y,et al.The prevention and treatment of stroke still face huge challenges:brief report on stroke prevention and treatment in China，2018［J］.Chin Cir J,2019,34(2):105-119.
［3］　HANKEY G J.Stroke［J］.Lancet,2017,389(10069):641-654.
［4］　甘勇,杨婷婷,刘建新,等.国内外脑卒中流行趋势及影响因素研究进展［J］.中国预防医学杂志,2019,20(2):139-144.
GAN Y,YANG T T,LIU J X,et al.Reseaarch progress on epidemic trend and influencing factors of stroke in the world［J］.Chin Prev Med,2019,20(2):139-144.
［5］　MI T,SUN S,DU Y,et al.Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China［J］.Brain Behav,2016,6(5):e00461.
［6］　WANG J,WEN X,LI W,et al.Risk factors for stroke in the Chinese population:a systematic review and meta-analysis［J］.J Stroke Cerebrovasc Dis,2017,26(3):509-517.
［7］　GUZIK A,BUSHNELL C.Stroke epidemiology and risk factor management［J］.Continuum (Minneap Minn),2017,23(1,Cerebrovascular Disease):15-39.
［8］　FELLING R J,SUN L R,MAXWELL E C,et al.Pediatric arterial ischemic stroke:epidemiology,risk factors,and management［J］.Blood Cells Mol Dis,2017,67:23-33.
［9］　HILL V A,TOWFIGHI A.Modifiable risk factors for stroke and strategies for stroke prevention［J］.Semin Neurol,2017,37(3):237-258.
［10］　MARSHALL I J,WANG Y,CRICHTON S,et al.The effects of socioeconomic status on stroke risk and outcomes［J］.Lancet Neurol,2015,14(12):1206-1218.
［11］　SINGH V,PRABHAKARAN S,CHATURVEDI S,et al.An exami-nation of stroke risk and burden in South Asians［J］.J Stroke Cerebrovasc Dis,2017,26(10):2145-2153.
［12］　MIRZAEI H.Stroke in women:risk factors and clinical biomar-kers［J］.J Cell Biochem,2017,118(12):4191-4202.
［13］　POORTHUIS M H,ALGRA A M,ALGRA A,et al.Female- and male-specific risk factors for stroke:a systematic review and meta-analysis［J］.JAMA Neurol,2017,74(1):75-81.
［14］　陈艳，胡发云，吴波.《中国脑血管疾病分类2015》解读［J］.中国现代神经疾病杂志，2017,17(12):865-868.
CHEN Y,HU F Y,WU B.Interpretation of “Chinese classification of cerebrovascular diseases (2015)”［J］.Chin J Contemp Neurol Neurosurg,2017,17(12):865-868.
［15］　SHEN S H,WORONIECKA K,BARBOUR A B,et al.CAR T cells and checkpoint inhibition for the treatment of glioblastoma［J］.Expert Opin Biol Ther,2020,20(6):579-591.
［16］　OSTROM Q T,BAUCHET L,DAVIS F G,et al.The epidemiology of glioma in adults:a "state of the science" review［J］.Neuro Oncol,2014,16(7):896-913.
［17］　INGRAM M,BUCKWALTER J G,JACQUES D B,et al.Immunotherapy for recurrent malignant glioma:an interim report on survival［J］.Neurol Res,1990,12(4):265-273.
［18］　ZHOU M,WANG H,ZENG X,et al.Mortality,morbidity,and risk factors in China and its provinces,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017［J］.Lancet,2019,394(10204):1145-1158.
［19］　HAO L,CHEN L,SAI X,et al.Synergistic effects of elevated homocysteine level and abnormal blood lipids on the onset of stroke［J］.Neural Regen Res,2013,8(31):2923-2931.
［20］　JIANG S,LI J,ZHANG Y,et al.Methylenetetrahydrofolate reductase C677T polymorphism,hypertension and risk of stroke:a prospective,nested case-control study［J］.Int J Neurosci,2017,127(3):253-260.
［21］　PANG H,HAN B,FU Q,et al.Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension［J］.Sci Rep,2018,8(1):3900.
［22］　LI J,JIANG S,ZHANG Y,et al.H-type hypertension and risk of stroke in chinese adults:a prospective,nested case-control study［J］.J Transl Int Med,2015,3(4):171-178.
［23］　陈同,李瑛,王春,等.低剂量口服避孕药、高血压及其联合作用对女性脑卒中发病危险性的影响［J］.中华疾病控制杂志,2014,18(2):135-138.
CHEN T，LI Y，WANG C，et al.The joint effects of hypertension and low-dose of COC on the risk of stroke in women［J］.Chin J Dis Control Prev,2014,18(2):135-138.
［24］　皇甫新凤.心血管病家族史和C反应蛋白及吸烟和高血压对脑卒中发病的联合作用［D］.苏州：苏州大学,2018.
HUANGFU X F.Combined effects of CVD family history and C-reactive protein and smoking and hypertension on stroke［D］.Suzhou:Suzhou University,2018.
［25］　STONE N J,ROBINSON J G，LICHTENSTEIN A H,et al.2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular′risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines［J］.J Am Coll Cardiol,2014，63(25 Pt B):2889-2934.
［26］　CHEN R,OVBIAGELE B,FENG W.Diabetes and stroke:epidemiology,pathophysiology,pharmaceuticals and outcomes［J］.Am J Med Sci,2016,351(4):380-386.
［27］　BOEHME A K,ESENWA C,ELKIND M S.Stroke risk factors,genetics,and prevention［J］.Circ Res,2017,120(3):472-495.
［28］　ALLOUBANI A,SALEH A,ABDELHAFIZ I.Hypertension and diabetes mellitus as a predictive risk factors for stroke［J］.Diabetes Metab Syndr,2018,12(4):577-584.
［29］　ZHENG J,YU Z,MA L,et al.Association between blood glucose and functional outcome in intracerebral hemorrhage:a systematic review and meta-analysis［J］.World Neurosurg,2018,114：e756-e765.
［30］　PAN Y,CAI X,JING J,et al.Stress hyperglycemia and prognosis of minor ischemic stroke and transient ischemic attack:the CHANCE study (clopidogrel in high-risk patients with acute nondisabling cerebrovascular events)［J］.Stroke,2017,48(11):3006-3011.
［31］　BELL D S H,GONCALVES E.Stroke in the patient with diabetes(part 1)-epidemiology,etiology,therapy and prognosis［J］.Diabetes Res Clin Pract,2020,164：108193.
［32］　SHI Z,GUAN Y,HUO Y R,et al.Elevated total homocysteine levels in acute ischemic stroke are associated with long-term mortality［J］.Stroke,2015,46(9):2419-2425.
［33］　CHRYSANT S G,CHRYSANT G S.The current status of homocysteine as a risk factor for cardiovascular disease:a mini review［J］.Expert Rev Cardiovasc Ther,2018,16(8):559-565.
［34］　ZHANG T,JIANG Y,ZHANG S,et al.The association between homocysteine and ischemic stroke subtypes in Chinese:a meta-analysis［J］.Medicine (Baltimore),2020,99(12):e19467.
［35］　ZHOU Z,LIANG Y,QU H,et al.Plasma homocysteine concentrations and risk of intracerebral hemorrhage:a systematic review and meta-analysis［J］.Sci Rep,2018,8(1):2568.
［36］　CASAUBON L K,BOULANGER J M,GLASSER E,et al.Canadian stroke best practice recommendations:acute inpatient stroke care guidelines,update 2015［J］.Int J Stroke,2016,11(2):239-252.
［37］　WOO K S,CHOOK P,LOLIN Y I,et al.Folic acid improves arterial endothelial function in adults with hyperhomocystinemia［J］.J Am Coll Cardiol,1999,34(7):2002-2006.
［38］　李晓青.2型糖尿病合并高同型半胱氨酸血症与动脉硬化性脑梗死的关系研究进展［J］.实用心脑肺血管病杂志,2020,28(7):1-5.
LI X Q.Research progress of the relationship between type 2 diabetes mellitus combined with hyper homocysteineme and atherosclerotic cerebral infarction［J］.PJCCPVD,2020,28(7):1-5.

相似文献/References:

[1]孟凡超,许予明,李枢,等.脑卒中患者入院时间及其部分影响因素的调查[J].新乡医学院学报,1997,14(04):396.
[2]王淑秀,赵长安,许春雷,等.同型半胱氨酸对内皮细胞单核细胞趋化蛋白一1表达的影响[J].新乡医学院学报,2003,20(02):086.
[3]王淑秀,赵长安,许春雷,等.同型半胱氨酸对内皮细胞单核细胞趋化蛋白O1 表达的影响[J].新乡医学院学报,2003,20(02):086.
[4]粱爱华.脑卒中吞咽障碍62例康复护理[J].新乡医学院学报,2003,20(03):224.
[5]梁爱华.脑卒中吞咽障碍62例康复护理[J].新乡医学院学报,2003,20(03):224.
[6]骆亚平,李敬东,李国选.血浆同型半胱氨酸水平与重度妊高征的关系[J].新乡医学院学报,2003,20(04):252.
[7]骆亚平,李敬东,李国选.血浆同型半胱氨酸水平与重度妊高征的关系[J].新乡医学院学报,2003,20(04):252.
[8]李西兴,周延升,时　岚,等.血脂和同型半胱氨酸对家兔动脉粥样硬化形成的影响[J].新乡医学院学报,2003,20(01):005.
[9]曹红军,张　静,尤海峰,等.盐酸舍曲林在脑卒中抑郁症恢复中的作用[J].新乡医学院学报,2003,20(01):053.
[10]李西兴,周延升,时．岚,等.血脂和同型半胱氨酸对家兔动脉粥样硬化形成的影响[J].新乡医学院学报,2003,20(01):005.

更新日期/Last Update: 2022-10-05