同型半胱氨酸、维生素B12和叶酸与美国中风成年患者全因死亡率风险之间的关联。
Associations between homocysteine, vitamin B12, and folate and the risk of all-cause mortality in American adults with stroke.
作者信息
Zhang Panpan, Xie Xia, Zhang Yurong
机构信息
Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
出版信息
Front Nutr. 2023 Nov 14;10:1279207. doi: 10.3389/fnut.2023.1279207. eCollection 2023.
OBJECTIVE
Associations between plasma homocysteine (Hcy), vitamin B12, and folate and the risk of all-cause mortality are unclear. This study aimed to examine whether plasma Hcy, vitamin B12, and folate levels independently predict the risk of all-cause mortality in American adults with stroke.
METHODS
Data from the United States National Health and Examination Survey (NHANES; 1999-2006) were used and linked with the latest (2019) National Death Index (NDI). Cox proportional hazards models and restricted cubic splines were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) of all-cause mortality for Hcy, folate, and B12 levels in adults with stroke. Sample weights were calculated to ensure the generalizability of the results.
RESULTS
A total of 431 participants were included (average age: 64.8 years). During a median follow-up of 10.4 years, 316 deaths occurred. Hcy was positively associated with all-cause mortality in adults with stroke (HR, 1.053; 95% CI: 1.026-1.080). Stroke patients with plasma Hcy levels in the fourth quartile had a 1.631-fold higher risk of all-cause mortality (HR, 1.631; 95% CI: 1.160-2.291) than those in the first quartile. The association between plasma Hcy and all-cause mortality was strong significant in older patients ( for interaction = 0.020). Plasma folate and vitamin B12 concentrations were inversely correlated with Hcy concentrations [B-value (95% CI): -0.032 (-0.056- -0.008), -0.004 (-0.007- -0.002), respectively]. No significant associations were observed between folate, vitamin B12 levels, and all-cause mortality in adults with stroke.
CONCLUSION
Plasma Hcy levels were positively associated with all-cause mortality in older adults with stroke. Folate and vitamin B12 levels were inversely correlated with Hcy. Plasma Hcy may serve as a useful predictor in mortality risk assessment and targeted intervention in adults with stroke.
目的
血浆同型半胱氨酸（Hcy）、维生素B12和叶酸与全因死亡率之间的关联尚不清楚。本研究旨在探讨血浆Hcy、维生素B12和叶酸水平是否能独立预测美国成年中风患者的全因死亡风险。
方法
使用来自美国国家健康与检查调查（NHANES；1999 - 2006年）的数据，并与最新的（2019年）国家死亡指数（NDI）相链接。采用Cox比例风险模型和受限立方样条来估计中风成年患者中Hcy、叶酸和B12水平的全因死亡率的风险比（HR）和95%置信区间（CI）。计算样本权重以确保结果的可推广性。
结果
共纳入431名参与者（平均年龄：64.8岁）。在中位随访10.4年期间，发生了316例死亡。Hcy与中风成年患者的全因死亡率呈正相关（HR，1.053；95% CI：1.026 - 1.080）。血浆Hcy水平处于第四四分位数的中风患者全因死亡风险比处于第一四分位数的患者高1.631倍（HR，1.631；95% CI：1.160 - 2.291）。血浆Hcy与全因死亡率之间的关联在老年患者中具有显著统计学意义（交互作用P值 = 0.020）。血浆叶酸和维生素B12浓度与Hcy浓度呈负相关[B值（95% CI）分别为 -0.032（-0.056 - -0.008），-0.004（-0.007 - -0.002）]。未观察到叶酸、维生素B12水平与中风成年患者全因死亡率之间存在显著关联。
结论
血浆Hcy水平与老年中风患者的全因死亡率呈正相关。叶酸和维生素B12水平与Hcy呈负相关。血浆Hcy可作为中风成年患者死亡风险评估和靶向干预的有用预测指标。
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