Cheng Yao, Kong Fan-Zhen, Dong Xiao-Feng, Xu Qin-Rong, Gui Qian, Wang Wei, Feng Hong-Xuan, Luo Wei-Feng, Gao Zong-En, Wu Guan-Hui
Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital)Suzhou 215002, China.
Department of Clinical Psychology, Suzhou Psychiatric HospitalSuzhou 215008, China.
Am J Transl Res. 2017 Oct 15;9(10):4553-4563. eCollection 2017.
We examined whether the association between total homocysteine (tHCY) and risk of ischemic stroke (IS) varies depending on renal function to gain insight into why tHCY-lowering vitamins do not reduce the incidence of cardiovascular disease in clinical trials. We analyzed data from 542 IS patients with large artery atherosclerosis (LAA) or small artery occlusion (SAO) after stratification by estimated glomerular filtration rate (eGFR) to evaluate renal function. We found that tHCY level was positively associated with the occurrence of IS in both LAA (OR: 1.159, 95% CI: 1.074-1.252, <0.001) and SAO (OR: 1.143, 95% CI: 1.064-1.228, <0.001) patients and in LAA (OR: 1.135, 95% CI: 1.047-1.230, =0.002) and SAO (OR: 1.159, 95% CI: 1.060-1.268, =0.001) subgroups with normal renal function but not in LAA or SAO subgroups with renal insufficiency. eGFR level was positively associated with IS in LAA (OR: 1.022, 95% CI: 1.010-1.034, <0.001) and SAO (OR: 1.024, 1.012-1.037, <0.001) subgroups with normal renal function but was negatively associated with IS in LAA (OR: 0.875, 95% CI: 0.829-0.925, <0.001) and SAO (OR: 0.890, 95% CI: 0.850-0.932, <0.001) subgroups with renal insufficiency. Folic acid level was negatively associated with IS in LAA (OR: 0.734, 95% CI: 0.606-0.889, =0.002) and SAO (OR: 0.861, 95% CI: 0.767-0.967, =0.012) subgroups with renal insufficiency. Therefore, renal function as evaluated by eGFR exerts a significant influence on the association between tHCY and risk of IS.
我们研究了总同型半胱氨酸（tHCY）与缺血性中风（IS）风险之间的关联是否因肾功能而异，以深入了解为何在临床试验中降低tHCY的维生素不能降低心血管疾病的发病率。我们分析了542例患有大动脉粥样硬化（LAA）或小动脉闭塞（SAO）的IS患者的数据，这些患者在通过估计肾小球滤过率（eGFR）分层后以评估肾功能。我们发现，在LAA（比值比：1.159，95%置信区间：1.074 - 1.252，<0.001）和SAO（比值比：1.143，95%置信区间：1.064 - 1.228，<0.001）患者中，以及在肾功能正常的LAA（比值比：1.135，95%置信区间：1.047 - 1.230，=0.002）和SAO（比值比：1.159，95%置信区间：1.060 - 1.268，=0.001）亚组中，tHCY水平与IS的发生呈正相关，但在肾功能不全的LAA或SAO亚组中并非如此。在肾功能正常的LAA（比值比：1.022，95%置信区间：1.010 - 1.034，<0.001）和SAO（比值比：1.024，1.012 - 1.037，<0.001）亚组中，eGFR水平与IS呈正相关，但在肾功能不全的LAA（比值比：0.875，95%置信区间：0.829 - 0.925，<0.001）和SAO（比值比：0.890，95%置信区间：0.850 - 0.932，<0.001）亚组中，eGFR水平与IS呈负相关。在肾功能不全的LAA（比值比：0.734，95%置信区间：0.6
