血浆总同型半胱氨酸水平与急性缺血性脑卒中患者早期出血性转化风险的关系：一项基于医院的研究。

Association Between Plasma Total Homocysteine Levels and Risk of Early Hemorrhagic Transformation in Patients with Acute Ischemic Stroke: A Hospital-Based Study.

机构信息

Department of Neurology, the Second Affiliated Hospital of Chengdu Medical College, (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China.

出版信息

J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105538. doi: 10.1016/j.jstrokecerebrovasdis.2020.105538. Epub 2020 Dec 17.

DOI:10.1016/j.jstrokecerebrovasdis.2020.105538

PMID:33341563

Abstract

OBJECTS

In this study, we investigated the association between plasma total homocysteine(tHcy) levels and the risk of early hemorrhagic transformation(HT) in patients with acute ischemic stroke(AIS).

METHODS

Consecutive hospitalized participants who met the inclusion criteria were enrolled and grouped according to plasma tHcy levels. Participants were divided into a low homocysteine level(L-tHcy) group (<12 µmol/L) and a high homocysteine level group(H-tHcy) (≥ 12 µmol/L). Baseline computed tomography (CT) examination was performed. HT was determined via CT or magnetic resonance imaging within 1 to 3 days after admission.

RESULTS

A total of 1858 patients were screened and 1378 patients completed the this study(797 patients in the H-tHcy group and 581 patients in the L-tHcy group). HT incidence was 5.2% (30/581,) in the L-tHcy group and 11.2% (90/797) in the H-tHcy group(P<0.05). Binary logistic regression analysis showed that initial NIHSS score, tHcy levels, treatment with recombinant tissue plasminogen activator thrombolysis, systolic blood pressure on admission, glucose level on admission, smoking status and estimated glomerular filtration rate were independent risk factors for HT. Receiver operating characteristic analysis showed that tHcy level was a moderately sensitive and specific index to predict the incidence of HT, and the optimal cutoff was 16.56 μmol/L (sensitivity 63.3%, specificity 41.3%).

CONCLUSION

Our study findings reveal that high plasma tHcy level is one independent risk factor associated with increased risk of early HT in patients with AIS.

摘要

目的

本研究旨在探讨血浆总同型半胱氨酸（tHcy）水平与急性缺血性脑卒中（AIS）患者早期出血性转化（HT）风险的关系。

方法

连续纳入符合纳入标准的住院患者，并根据血浆 tHcy 水平进行分组。将患者分为低同型半胱氨酸水平组（L-tHcy，<12μmol/L）和高同型半胱氨酸水平组（H-tHcy，≥12μmol/L）。所有患者入院后均行基线计算机断层扫描（CT）检查。入院后 1 至 3 天内通过 CT 或磁共振成像确定 HT。

结果

共筛选出 1858 例患者，其中 1378 例完成了此项研究（H-tHcy 组 797 例，L-tHcy 组 581 例）。L-tHcy 组 HT 发生率为 5.2%（30/581），H-tHcy 组为 11.2%（90/797）（P<0.05）。二元逻辑回归分析显示，初始 NIHSS 评分、tHcy 水平、重组组织型纤溶酶原激活物溶栓治疗、入院时收缩压、入院时血糖水平、吸烟状况和估算肾小球滤过率是 HT 的独立危险因素。受试者工作特征曲线分析显示，tHcy 水平是预测 HT 发生率的一个中度敏感和特异的指标，最佳截断值为 16.56μmol/L（灵敏度 63.3%，特异性 41.3%）。