From the Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea (H.-M.K., Y.-S.L.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (H.-J.B.); and Department of Neurology, Asan Medical Center, Seoul, South Korea (D.-W.K.).
Stroke. 2014 Mar;45(3):871-3. doi: 10.1161/STROKEAHA.113.004099. Epub 2014 Jan 21.
Hyperhomocysteinemia is a well-known risk factor for vascular disease. However, its action, mechanism, and role in the acute phase of stroke have not been determined. We tried to determine whether an association existed between elevated serum homocysteine levels and early neurological deterioration (END) in patients with acute ischemic stroke.
We performed a secondary analysis from the Cilostazol in Acute Ischemic Stroke Treatment (CAIST) trial, which was a double-blinded, randomized, multicenter trial, assessing the noninferiority of cilostazol over aspirin within 48 hours of an acute ischemic stroke. END was defined as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale score within 7 days.
The mean (±SD) serum homocysteine level was 11.4±4.7 μmol/L. Of the 396 patients studied, 57 (14.4%) patients worsened during the 7 days after inclusion. Most (68%) of the END cases occurred within the first 24 hours after treatment. High levels (>10.3 μmol/L) of serum homocysteine were independent predictors for END (third quartile odds ratio, 3.45; 95% confidence intervals, 1.25-9.50; P=0.016; fourth quartile odds ratio, 3.36; 95% confidence intervals 1.18-9.52; P=0.023) in multivariate analysis.
Patients with acute stroke with elevated serum homocysteine levels are at an increased risk for END.
高同型半胱氨酸血症是血管疾病的一个众所周知的危险因素。然而，其在中风急性期的作用、机制和作用尚未确定。我们试图确定急性缺血性中风患者血清同型半胱氨酸水平升高与早期神经功能恶化（END）之间是否存在关联。
我们对 Cilostazol 在急性缺血性中风治疗（CAIST）试验进行了二次分析，该试验是一项双盲、随机、多中心试验，评估了急性缺血性中风后 48 小时内西洛他唑与阿司匹林的非劣效性。END 定义为在 7 天内运动力量增加≥1 点或 NIHSS 总分增加≥2 分。
平均（±SD）血清同型半胱氨酸水平为 11.4±4.7 μmol/L。在研究的 396 名患者中，57 名（14.4%）患者在纳入后 7 天内恶化。大多数（68%）的 END 病例发生在治疗后 24 小时内。高水平（>10.3 μmol/L）血清同型半胱氨酸是 END 的独立预测因素（第三四分位数比值，3.45；95%置信区间，1.25-9.50；P=0.016；第四四分位数比值，3.36；95%置信区间，1.18-9.52；P=0.023）在多变量分析中。
急性中风患者血清同型半胱氨酸水平升高，发生 END 的风险增加。
