CAJ | 학술논문

目的揭示高血压患者同型半胱氨酸(Hcy)与卒中的关系.方法采用前瞻性队列研究设计,对深圳市南山区60个社区的5 488例高血压患者进行基线调查和平均2.7年随访.Hcy采用循环酶法检测,卒中包括ICD-10编码中I60-I64的类型,根据患者的院前症状、头颅CT、头颅MRI、脑血管造影和经颅多普勒超声等检查结果进行确诊.结果 5 488例高血压人群327例失访,失访率5.96％,新发卒中患者197例,累积发病率3.82％.在矫正年龄、性别、教育、吸烟、饮酒、BMI、体育锻炼、糖尿病、抑郁、卒中家族史、患病年限、降压药、叶酸、收缩压、TC、血糖和TG后,Hcy最高四分位数(Q4)与最低四分位数(Q1)相比,Hcy引发卒中的HR为7.4(3.2 ～13.2),其中男性7.5(3.0 ～19.5),女性7.7(2.7 ～22.1).Hcy每增加5μmol/L引发卒中的HR为1.15(1.09 ～1.21),其中男性和女性分别为1.15(1.08～1.21)和1.19(1.04～1.35);未发现Hcy与心脑血管疾病传统危险因素对卒中具有交互作用.结论高血压患者中Hcy水平和卒中可能具有正相关的关系.
목적 게시고혈압환자동형반광안산(Hcy)여졸중적관계.방법 채용전첨성대렬연구설계,대심수시남산구60개사구적5 488례고혈압환자진행기선조사화평균2.7년수방.Hcy채용순배매법검측,졸중포괄ICD-10편마중I60-I64적류형,근거환자적원전증상、두로CT、두로MRI、뇌혈관조영화경로다보륵초성등검사결과진행학진.결과 5 488례고혈압인군327례실방,실방솔5.96％,신발졸중환자197례,루적발병솔3.82％.재교정년령、성별、교육、흡연、음주、BMI、체육단련、당뇨병、억욱、졸중가족사、환병년한、강압약、협산、수축압、TC、혈당화TG후,Hcy최고사분위수(Q4)여최저사분위수(Q1)상비,Hcy인발졸중적HR위7.4(3.2 ～13.2),기중남성7.5(3.0 ～19.5),녀성7.7(2.7 ～22.1).Hcy매증가5μmol/L인발졸중적HR위1.15(1.09 ～1.21),기중남성화녀성분별위1.15(1.08～1.21)화1.19(1.04～1.35);미발현Hcy여심뇌혈관질병전통위험인소대졸중구유교호작용.결론 고혈압환자중Hcy수평화졸중가능구유정상관적관계.
Objective To analyze the association between homocysteine (Hcy) and stroke in hypertensive patients.Methods This was a prospective cohort study conducted in 60 communities in Nanshan District,Shenzhen.Totally 5 488 patients with hypertension were included at baseline survey and followed for an average of 2.7 years.At the end of follow-up,327 (5.96％) subjects were missing with unknown reasons.Hcy was detected by enzymatic cycling method.Head CT,MRI,cerebral angiography and transcranial Doppler ultrasound were performed in the patients.Stroke was defined based on the International Classification of Diseases (ICD10 coding I60-I64).Results After an average of 2.7-year follow-up,197 developed new stroke.The incidence rate was 3.82％.Subjects whose Hcy levels were within the highest quartile (Q4) had higher risk to develop stroke compared with those whose Hey levels were within the lowest quartile (Q1).The HR (95％ CI) were 7.4 (3.2-13.2) in total with 7.5 (3.0-19.5) in men and 7.7(2.7-22.1) in women after adjustment of age,sex,education,smoking,alcohol drinking,and BMI,physical activity,diabetes,depression,family history of stroke or coronary heart disease,years of hypertension,antihypertensive drugs,folic acid,systolic blood pressure,TC,glucose and TG.For every 5 μmol/L increase in Hcy,the HR (95％ CI) of stroke increased 1.15-fold (1.09-1.21) in total subjects with 1.15(1.08-1.21) in men and 1.19(1.04-1.35) in women,respectively.No significant interactions on stroke could be found between Hcy and the above stratified factors.Conclusion Elevated Hcy levels were associated with stroke in hypertensive patients.