Luo Hongzhi, Liu Bo, Hu Jing, Wang Xian, Zhan Siyan, Kong Wei
Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, PR China.
Cerebrovasc Dis. 2014;37(5):313-22. doi: 10.1159/000360753. Epub 2014 Jun 4.
Cervical artery dissection (CAD) is a recognized cause of ischemic stroke. Hyperhomocysteinemia (HHcy), i.e. an elevated concentration of plasma homocysteine, is identified as an independent risk factor for stroke prevalence. However, an association between HHcy and CAD has so far remained unknown.
A meta-analysis was performed to analyze the association between HHcy and CAD as well as the relevance of the C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR), the key enzyme in homocysteine metabolism during CAD. We searched PubMed and Embase for studies reporting homocysteine concentrations or MTHFR genotype frequencies in CAD patients from 1990 to 2013. Outcomes were extracted from studies meeting the inclusion criteria and were subjected to a meta-analysis by the random-effect model. Heterogeneity was assessed by the I(2) test.
Eight case-control studies with 2,146 individuals fulfilled the required criteria and were included in the meta-analysis. HHcy was found to be significantly associated with CAD (pooled standardized mean difference: 0.96; 95% confidence interval, CI: 0.42-1.49; p < 0.01). We also found a significantly increased risk of CAD in individuals with the MTHFR C677T polymorphism by both the recessive model (TT vs. CT+CC; odds ratio, OR = 1.81; 95% CI: 1.22-2.67; p = 0.003) and the dominant model (TT+CT vs. CC; OR = 1.47; 95% CI: 1.08-1.99; p = 0.014).
Our data suggest positive correlations between HHcy and CAD and between the C677T polymorphism of MTHFR and CAD.
颈动脉夹层（CAD）是缺血性卒中的一个公认病因。高同型半胱氨酸血症（HHcy），即血浆同型半胱氨酸浓度升高，被确定为卒中患病率的一个独立危险因素。然而，HHcy与CAD之间的关联迄今仍不明确。
进行一项荟萃分析，以分析HHcy与CAD之间的关联以及亚甲基四氢叶酸还原酶（MTHFR）C677T多态性（CAD期间同型半胱氨酸代谢的关键酶）的相关性。我们在PubMed和Embase中检索了1990年至2013年期间报告CAD患者同型半胱氨酸浓度或MTHFR基因型频率的研究。从符合纳入标准的研究中提取结果，并采用随机效应模型进行荟萃分析。通过I²检验评估异质性。
八项病例对照研究（共2146名个体）符合所需标准并纳入荟萃分析。发现HHcy与CAD显著相关（合并标准化均数差：0.96；95%置信区间，CI：0.42 - 1.49；p < 0.01）。我们还发现，在隐性模型（TT与CT + CC相比；比值比，OR = 1.81；95% CI：1.22 - 2.67；p = 0.003）和显性模型（TT + CT与CC相比；OR = 1.47；95% CI：1.08 - 1.99；p = 0.014）下，具有MTHFR C677T多态性的个体患CAD的风险显著增加。
我们的数据表明HHcy与CAD之间以及MTHFR的C677T多态性与CAD之间存在正相关。
