急性缺血性脑卒中患者同型半胱氨酸水平与出院结局的关联研究

摘要

Objective To investigate the relationship between plasma homocysteine on admission and the outcome at discharge of acute ischemic stroke.Methods A non-concurrent cohort study was performed and a total of 1 3 1 9 patients with acute is-chemic stroke were continuously included in this study.According to tertile range of plasma homocysteine,patients were di-vided into three group.Logistic regression analysis was used to assess the independent association between plasma homocys-teine on admission and poor outcome at discharge of acute ischemic stroke.Results The difference of plasma homocysteine on admission between the poor outcome and those with good outcome had statistical significance (P<0.000 1).Without the adj ustment of multiple factors,when comparing to the first group,the second and third tertile seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 2.111 (1.297~3.437,P<0.05),2.113 (1.361~3.279,P<0.05).After adjustment for multivariate,the second and third tertile also seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 1.876 (1.160~3.036,P<0.05),2.396 (1.414~4.062,P<0.05).Conclusion The current study indicated that higher plasma homocysteine level was an independent risk factor for poor outcome at discharge in ischemic stroke patients.It would increase the risk of the outcome at discharge in patients with acute ischemic stroke,and suggests that there is a dose-response relationship between plasma homocysteine level on admis-sion and the poor outcome at discharge.%目的：探讨入院时血浆同型半胱氨酸水平与急性缺血性脑卒中患者出院结局不良的关系。方法采用回顾性队列研究的方法，连续性纳入1319例急性缺血性脑卒中住院患者，按入院时血浆同型半胱氨酸水平分为3组，采用非条件logistic回归分析入院时血浆同型半胱氨酸水平与急性缺血性脑卒中出院结局不良的关系。结果结局良好与结局不良组之间入院时血浆同型半胱氨酸水平差异有统计学意义（P＜0.0001）。以血浆同型半胱氨酸水平第1组为参比，第2，3组发生出院结局不良的 OR值（95％CI）分别为2.111（1.297～3.437，P＜0.05），2.113（1.361～3.279，P＜0.05）；经多因素调整后，第2，3组仍有增加急性缺血性脑卒中出院结局不良的风险，OR值（95％CI）分别为1.876（1.160～3.036，P＜0.05），2.396（1.414～4.062，P＜0.05）。结论入院时血浆同型半胱氨酸水平升高可增加急性缺血性脑卒中患者出院结局不良发生率的风险，是独立的危险因素，血浆同型半胱氨酸水平越高不良结局的风险越高。