同型半胱氨酸与老年人入住养老院和死亡的风险。

Homocysteine and the risk of nursing home admission and mortality in older persons.

机构信息

Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

出版信息

Eur J Clin Nutr. 2012 Feb;66(2):188-95. doi: 10.1038/ejcn.2011.186. Epub 2011 Nov 9.

DOI:10.1038/ejcn.2011.186

PMID:22071796

Abstract

BACKGROUND/OBJECTIVES: This study aimed to investigate whether higher homocysteine and lower vitamin B12 concentrations increase the risk of future nursing home (NH) admission and all-cause mortality in independently living older persons.

SUBJECTS/METHODS: In total, 1117 independently living participants (mean age=75.1, s.d.=6.4) were included in this prospective sub-study of the Longitudinal Aging Study Amsterdam. EDTA plasma samples, collected in 1995-1996, were analysed for total homocysteine (μmol/l). Time to NH admission was assessed using a follow-up until 2002-2003. In addition, we studied mortality until 1 June 2007. Cox proportional hazards models were used to examine the association between homocysteine in quartiles and risk of NH admission and mortality.

RESULTS

During follow-up, 126 persons (11.3%) were admitted to NHs, and 513 persons (45.9%) deceased. In men, no significant associations were observed. In women, after adjustment for confounding, the highest quartile of homocysteine was associated with a significantly higher risk of NH admission compared with the first quartile (hazard ratio (HR)=2.97, 95% confidence interval (CI)=1.36-6.49). Both women in the third and the fourth quartile of homocysteine had a significantly higher mortality risk (HR=1.70, 95% CI=1.08-2.65 and HR=1.91, 95% CI=1.22-3.00, respectively) compared with the first quartile. Vitamin B12 was not related to an increased risk of NH admission and mortality.

CONCLUSIONS

Elevated plasma homocysteine is associated with an increased risk of NH admission and mortality in older women, but not in older men.

摘要

背景/目的：本研究旨在探讨同型半胱氨酸升高和维生素 B12 浓度降低是否会增加独立生活的老年人未来入住养老院（NH）和全因死亡率的风险。

受试者/方法：本前瞻性研究纳入了 1117 名独立生活的参与者（平均年龄=75.1，标准差=6.4），这些参与者来自阿姆斯特丹纵向老龄化研究的一个亚研究。于 1995-1996 年采集 EDTA 血浆样本，以检测总同型半胱氨酸（μmol/l）。使用随访至 2002-2003 年的方法评估入住 NH 的时间。此外，我们还研究了截至 2007 年 6 月 1 日的死亡率。使用 Cox 比例风险模型来检验同型半胱氨酸四分位数与 NH 入住和死亡率风险之间的关系。

结果

在随访期间，126 人（11.3%）入住 NH，513 人（45.9%）死亡。在男性中，未观察到显著相关性。在女性中，在调整混杂因素后，与第一四分位数相比，同型半胱氨酸最高四分位数与 NH 入住的风险显著升高相关（风险比（HR）=2.97，95%置信区间（CI）=1.36-6.49）。与第一四分位数相比，同型半胱氨酸处于第三和第四四分位数的女性死亡率风险显著升高（HR=1.70，95% CI=1.08-2.65 和 HR=1.91，95% CI=1.22-3.00）。维生素 B12 与 NH 入住和死亡率风险增加无关。