Choi Seung-Hye, Choi-Kwon Smi, Kim Min-Sun, Kim Jong-Sung
Department of Nursing Science, Suwon University, Gyeonggi 447-743, Korea.
College of Nursing & Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongro-Gu, Seoul 110-799, Korea.
Nutr Res Pract. 2015 Oct;9(5):503-10. doi: 10.4162/nrp.2015.9.5.503. Epub 2015 Aug 20.
BACKGROUND/OBJECTIVES: Increased serum homocysteine (Hcy) levels have been reported to be related to the occurrence of cardio- and cerebrovascular diseases. High serum Hcy levels are also related to the development of secondary stroke and all-cause mortality. The purpose of this study was to investigate the prevalence of high serum homocysteine level and relating factors, and the change over the 10 month period post-stroke.
SUBJECTS/METHODS: Consecutive stroke patients who were admitted to the Asan Medical Center were enrolled. Ten months after the onset of stroke, an interview with a structured questionnaire was performed and blood samples were obtained for the biochemical parameters. Nutritional status was determined using the mini nutritional assessment (MNA) score and dietary nutrient intakes were also obtained using a 24 hour recall method.
Out of 203 patients, 84% were malnourished or at risk of malnutrition, and 26% had high homocysteine levels at 10 months post-stroke. Using logistic regression, the factors related with high homocysteine levels at 10 months post-stroke included heavy alcohol consumption (P = 0.020), low MNA scores (P = 0.026), low serum vitamin B12 (P = 0.021) and low serum folate levels (P = 0.003). Of the 156 patients who had normal homocysteine levels at admission, 36 patients developed hyperhomocysteinemia 10 months post-stroke, which was related to heavy alcohol consumption (P = 0.013). Persistent hyperhomocysteinemia, observed in 22 patients (11%), was related to male sex (P = 0.031), old age (P = 0.042), low vitamin B6 intake (P = 0.029), and heavy alcohol consumption (P = 0.013).
Hyperhomocysteinemia is common in post-stroke, and is related to malnutrition, heavy alcohol drinking and low serum level of folate and vitamin B12. Strategies to prevent or manage high homocysteine levels should consider these factors.
背景/目的：据报道，血清同型半胱氨酸（Hcy）水平升高与心脑血管疾病的发生有关。高血清Hcy水平还与继发性中风的发展和全因死亡率有关。本研究的目的是调查高血清同型半胱氨酸水平的患病率及其相关因素，以及中风后10个月期间的变化情况。
对象/方法：纳入连续入住峨山医学中心的中风患者。中风发作10个月后，进行结构化问卷调查访谈，并采集血样检测生化参数。使用微型营养评定法（MNA）评分确定营养状况，并采用24小时回顾法获取膳食营养素摄入量。
203例患者中，84%存在营养不良或有营养不良风险，26%在中风后10个月时同型半胱氨酸水平较高。采用逻辑回归分析，中风后10个月时与高同型半胱氨酸水平相关的因素包括大量饮酒（P = 0.020）、低MNA评分（P = 0.026）、低血清维生素B12水平（P = 0.021）和低血清叶酸水平（P = 0.003）。入院时同型半胱氨酸水平正常的156例患者中，36例在中风后10个月出现高同型半胱氨酸血症，这与大量饮酒有关（P = 0.013）。22例患者（11%）出现持续性高同型半胱氨酸血症，这与男性（P = 0.031）、老年（P = 0.042）、低维生素B6摄入量（P = 0.029）和大量饮酒（P = 0.013）有关。
高同型半胱氨酸血症在中风后很常见，并且与营养不良、大量饮酒以及低血清叶酸和维生素B12水平有关。预防或控制高同型半胱氨酸水平的策略应考虑这些因素。
