Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
Center for Disease Prevention and Control of Gusu District, Suzhou, China.
Curr Neurovasc Res. 2019;16(1):82-88. doi: 10.2174/1567202616666190207161818.
Methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms have been reported to be associated with ischemic stroke. However, the association between serum MTHFR level and ischemic stroke has not yet been studied. We aimed to examine the association between them in patients with large-artery atherosclerotic stroke and community-based healthy controls.
This study includes three hundred ninety-five patients with large-artery atherosclerotic stroke from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) and 395 age- and sex-matched healthy controls from Chinese communities. Serum MTHFR concentrations were examined and some conventional risk factors of stroke were collected. The association between serum MTHFR and large-artery atherosclerotic stroke was evaluated.
A U-shaped association of serum MTHFR level with large-artery atherosclerotic stroke was observed (p for nonlinearity =0.008). After multivariate adjustment, the odds ratios (95% confidence intervals) of large-artery atherosclerotic stroke associated with the first, second, fourth, and fifth quintiles of MTHFR were 5.62 (1.10-28.87), 2.13 (0.51-8.99), 1.08 (0.21-5.56), and 2.31 (0.57-9.34), respectively, compared with the third quintiles of MTHFR. Adding MTHFR quintiles to a model containing conventional risk factors improved the predictive power for large-artery atherosclerotic stroke (continuous net reclassification improvement=63.78%, p<0.001; categorical net reclassification improvement=2.54%, p=0.012).
There is a significant U-shaped relationship between serum MTHFR levels and largeartery atherosclerotic stroke. Our findings raise the possibility that serum MTHFR may have a potential role in the pathogenesis of large-artery atherosclerotic stroke.
亚甲基四氢叶酸还原酶（MTHFR）基因多态性与缺血性脑卒中有关。然而，血清 MTHFR 水平与缺血性脑卒中之间的关系尚未得到研究。我们旨在研究大动脉粥样硬化性脑卒中患者与社区健康对照者之间的相关性。
本研究纳入了来自中国急性缺血性脑卒中降压试验（CATIS）的 395 例大动脉粥样硬化性脑卒中患者和来自中国社区的 395 例年龄和性别匹配的健康对照者。检测了血清 MTHFR 浓度，并收集了一些脑卒中的常规危险因素。评估了血清 MTHFR 与大动脉粥样硬化性脑卒中之间的关系。
血清 MTHFR 水平与大动脉粥样硬化性脑卒中呈 U 型相关（非线性检验 p=0.008）。经多变量调整后，MTHFR 水平处于第一、二、四和五分位数的大动脉粥样硬化性脑卒中的比值比（95%置信区间）分别为 5.62（1.10-28.87）、2.13（0.51-8.99）、1.08（0.21-5.56）和 2.31（0.57-9.34），与 MTHFR 水平处于第三五分位数相比。将 MTHFR 五分位数纳入包含常规危险因素的模型中，可提高大动脉粥样硬化性脑卒中的预测能力（连续净重新分类改善=63.78%，p<0.001；分类净重新分类改善=2.54%，p=0.012）。
血清 MTHFR 水平与大动脉粥样硬化性脑卒中之间存在显著的 U 型关系。我们的研究结果提示，血清 MTHFR 可能在大动脉粥样硬化性脑卒中的发病机制中发挥潜在作用。
