Yu Ling, Yang Lei, Li Yue, Yang Shuna, Gu Hua, Hu Wenli, Gao Shan
Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Int J Neurosci. 2020 Mar;130(3):231-236. doi: 10.1080/00207454.2019.1667795. Epub 2019 Dec 20.
Hyperhomocysteinemia (Hhcy) is a risk factor for stroke. Several studies have demonstrated that Hhcy was more closely linked to small vessel occlusive disease and white matter hyperintensities (WMH) in general and elderly population. Studies on WMH and homocysteine in elderly subjects are rare, and the results were inconsistent. Our study aimed to investigate the relationship between the serum homocysteine (HCY) and the severity of WMH in elderly lacunar stroke patients. Consecutive elderly (≥60 years old) lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to periventricular WMH (PVWMH) and deep WMH (DWMH) Fazekas scores. Patients with a Fazekas score (PVWMH or DWMH) of 0, 1, 2 were in mild-moderate group and 3 were in severe group. Vascular risk factors and clinical features were compared between these two groups. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors. A total of 587 participants aged 60-95 years were enrolled. Patients with severe PVWMH ( = 178) had higher age ( = 0.030) and higher incidence of stroke history (<0.001) than those in mild-moderate group. The level of serum HCY was significantly higher in patients with severe PVWMH ( ＝ 0.002). Patients with severe DWMH ( = 142) had higher age (<0.001) and often had a history of stroke (<0.001). The level of HCY was higher in patients with severe degree of DWMH, but had no significance ( ＝ 0.153). Multivariable logistic regression analyses showed Hhcy were independently associated with severe PVWMH after adjusted for age and vascular risk factors ( ＝ 0.014). Hhcy was independently associated with severe PVWMH of elderly lacunar stroke patients, but not DWMH.
高同型半胱氨酸血症（Hhcy）是中风的一个危险因素。多项研究表明，一般人群及老年人群中，Hhcy与小血管闭塞性疾病及白质高信号（WMH）联系更为紧密。关于老年受试者中WMH与同型半胱氨酸的研究较少，且结果不一致。我们的研究旨在调查老年腔隙性中风患者血清同型半胱氨酸（HCY）与WMH严重程度之间的关系。在这项横断面研究中，招募了连续的老年（≥60岁）腔隙性梗死患者。所有患者根据脑室周围WMH（PVWMH）和深部WMH（DWMH）的 Fazekas评分分为两组。Fazekas评分（PVWMH或DWMH）为0、1、2的患者属于轻-中度组，评分为3的患者属于重度组。比较两组之间的血管危险因素和临床特征。采用多因素logistic回归分析来确定WMH严重程度与血管危险因素之间的关系。共纳入了587名年龄在60-95岁的参与者。重度PVWMH患者（n = 178）比轻-中度组患者年龄更大（P = 0.030），中风病史发生率更高（P < 0.001）。重度PVWMH患者的血清HCY水平显著更高（P = 0.002）。重度DWMH患者（n = 142）年龄更大（P < 0.001），且常有中风病史（P < 0.001）。DWMH重度患者的HCY水平更高，但无统计学意义（P = 0.153）。多变量logistic回归分析显示，在调整年龄和血管危险因素后，Hhcy与重度PVWMH独立相关（P = 0.014）。Hhcy与老年腔隙性中风患者的重度PVWMH独立相关，但与DWMH无关。
