Cao Liming, Guo Yi, Zhu Zhishan
Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Neurology, Shenzhen People's Hospital, Shenzhen, China.
Int J Neurosci. 2021 Apr;131(4):362-369. doi: 10.1080/00207454.2020.1744597. Epub 2020 Apr 1.
Hyperhomocysteinemia is closely related to, but is not a confirmed risk factor of, cerebral small vessel disease (CSVD). This study aimed to determine whether hyperhomo-cysteinemia is correlated significantly with CSVD. This cross-sectional study compared the homocysteine (Hcy) levels of patients with and without CSVD. High-sensitivity C-reactive protein (hs-CRP) levels were compared according to white matter lesion (WML) severity, which was classified using the Fazekas system. Risk factors for ischemic CSVD were analyzed through multivariate unconditional logistic regression analysis. Hcy levels were significantly higher in patients with lacunar infarction (LI) than in controls (p=.0438), in patients with Fazekas 2-3 than in patients with Fazekas 0-1 WMLs (p=.0192), in patients with Fazekas 4-6 than in patients with Fazekas 2-3 WMLs (p=.0207), and in patients with LI than in patients without LI (p=.0043). hs-CRP levels were significantly higher in patients with LI than in patients without LI (p=.0068) and in patients with Fazekas 4-6 than in patients with Fazekas 0-1 WMLs (p=.0031). Three multivariate unconditional logistic regression analyses showed that hyperhomocysteinemia is a risk factor for LI (p=.006; odds ratio [OR], 27.668), severe WML (p=.028; OR, 1.984), and high hs-CRP level (p=.016; OR, 3.956). The assessment of Hcy levels is important for ischemic CSVD. Hyperhomocysteinemia is a risk factor for LI and severe WML. Further, hyperhomocysteinemia is associated with high hs-CRP levels, and this may involve an inflammatory mechanism; however, further studies are needed in this regard.
高同型半胱氨酸血症与脑小血管病（CSVD）密切相关，但并非已确认的风险因素。本研究旨在确定高同型半胱氨酸血症是否与CSVD显著相关。这项横断面研究比较了有和没有CSVD的患者的同型半胱氨酸（Hcy）水平。根据使用Fazekas系统分类的白质病变（WML）严重程度比较了高敏C反应蛋白（hs-CRP）水平。通过多变量无条件逻辑回归分析分析缺血性CSVD的风险因素。腔隙性脑梗死（LI）患者的Hcy水平显著高于对照组（p = 0.0438），Fazekas 2-3级患者的Hcy水平高于Fazekas 0-1级WML患者（p = 0.0192），Fazekas 4-6级患者的Hcy水平高于Fazekas 2-3级WML患者（p = 0.0207），LI患者的Hcy水平高于无LI患者（p = 0.0043）。LI患者的hs-CRP水平显著高于无LI患者（p = 0.0068），Fazekas 4-6级患者的hs-CRP水平高于Fazekas 0-1级WML患者（p = 0.0031）。三项多变量无条件逻辑回归分析表明，高同型半胱氨酸血症是LI的风险因素（p = 0.006；比值比[OR]，27.668）、严重WML的风险因素（p = 0.028；OR，1.984）和高hs-CRP水平的风险因素（p = 0.016；OR，3.956）。评估Hcy水平对缺血性CSVD很重要。高同型半胱氨酸血症是LI和严重WML的风险因素。此外，高同型半胱氨酸血症与高hs-CRP水平相关，这可能涉及炎症机制；然而，在这方面还需要进一步研究。
