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.
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; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Atherosclerosis. 2019 Jun;285:163-169. doi: 10.1016/j.atherosclerosis.2019.04.203. Epub 2019 Apr 13.
The association between homocysteine and prognosis of ischemic stroke remains controversial, and the role of platelet count on the effects of homocysteine in the prognosis of ischemic stroke is still not elucidated.
A total of 3229 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) with homocysteine and platelet measurements were included in this analysis. They were prospectively followed up for death, recurrent stroke and vascular events within 1 year after acute ischemic stroke.
There was a significant interaction effect between platelet count and homocysteine level on death (p for interaction < 0.05) within 1 year after ischemic stroke. After multivariate adjustment, high homocysteine level was associated with increased risk of 1-year mortality in patients with low platelet level (hazard ratio, 1.70; 95% confidence interval, 1.01-2.88) but not in those with high platelet level (hazard ratio, 1.08; 95% confidence interval, 0.65-1.75). The addition of homocysteine to a model containing conventional risk factors improved risk prediction of 1-year death (net reclassification index 0.53%, p < 0.001; integrated discrimination improvement 0.07%, p < 0.001).
High homocysteine may be merely an independent risk factor of death in ischemic stroke patients with low platelet levels. Further prospective studies from other populations and randomized clinical trials are needed to verify our findings and clarify the potential mechanisms.
同型半胱氨酸与缺血性卒中预后之间的关系仍存在争议，血小板计数在同型半胱氨酸对缺血性卒中预后影响中的作用尚不清楚。
本研究共纳入了 3229 例来自中国急性缺血性脑卒中降压试验（CATIS）且检测了同型半胱氨酸和血小板的急性缺血性脑卒中患者。前瞻性随访这些患者在急性缺血性脑卒中后 1 年内的死亡、复发卒中和血管事件。
在缺血性卒中后 1 年内，血小板计数和同型半胱氨酸水平之间存在显著的交互作用（p 值<0.05）。经多变量校正后，高同型半胱氨酸水平与低血小板水平患者的 1 年死亡率升高相关（风险比，1.70；95%置信区间，1.01-2.88），但与高血小板水平患者的 1 年死亡率升高无关（风险比，1.08；95%置信区间，0.65-1.75）。将同型半胱氨酸加入包含传统危险因素的模型中，可以改善 1 年死亡风险的预测（净重新分类指数 0.53%，p<0.001；综合判别改善 0.07%，p<0.001）。
高同型半胱氨酸可能仅是血小板水平较低的缺血性卒中患者死亡的一个独立危险因素。需要来自其他人群的前瞻性研究和随机临床试验来验证我们的发现并阐明潜在机制。
