高血压患者血同型半胱氨酸与急性心脑血管事件相关性的巢式病例对照研究
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摘要
【目的】探讨高血压患者血同型半胱氨酸水平与急性心脑血管事件发生的关系。【方法】采用巢式病例对照的研究方法从随访4年的13 209例新发高血压患者中观察到197例发生过急性心脑血管事件,采用病例对照1︰1进行匹配,利用卡方检验、配对t检验、条件logistics回归对数据进行分析。【结果】研究对象的血同型半胱氨酸几何均数为14.63μmol/L,男性(16.07μmol/L)高于女性(13.02μmol/L),F=20.67,P<0.01。病例组血同型半胱氨酸几何均数为15.07μmol/L,与对照组(14.20μmol/L)间差异无统计学意义(t=0.53,P=0.60)。进一步控制多种混杂因素后,血同型半胱氨酸与心脑血管急性事件间无关联。【结论】血同型半胱氨酸与急性心脑血管事件间的关系并不是很明确,需对此进行进一步的研究。
[Objective] To explore the relationship between homocysteine(Hcy) and acute cardiovascular and cerebrovascular events in patients with hypertension. [Methods] By nested case control method 197 cases of acute cardiovascular and cerebrovascular events among 13 209 cases of new developed hypertension were observed;the case control was matched by 1︰1.The data were analyzed by chi square test,paired t test,and unconditional logistics regression. [Results] Among the subjects in the study,the geometric mean of homocysteine was 14.63 μmol/L,the male was 16.07 μmol/L,which was higher than that of the female(13.02 μmol/L)(F=20.67,P<0.001).The geometric mean of homocysteine in the case group was 15.07 μmol/L,and there was no significant difference(t=0.53,P=0.60) between case group and control group(14.63 μmol/L) in this regard.There was no correlation between Hcy and acute cardiovascular and cerebrovascular events after further control of multiple confounding factors. [Conclusion] The relationship between Hcy and acute cardiovascular and cerebrovascular events is not very clear.Further study is needed.
[Objective] To explore the relationship between homocysteine(Hcy) and acute cardiovascular and cerebrovascular events in patients with hypertension. [Methods] By nested case control method 197 cases of acute cardiovascular and cerebrovascular events among 13 209 cases of new developed hypertension were observed;the case control was matched by 1︰1.The data were analyzed by chi square test,paired t test,and unconditional logistics regression. [Results] Among the subjects in the study,the geometric mean of homocysteine was 14.63 μmol/L,the male was 16.07 μmol/L,which was higher than that of the female(13.02 μmol/L)(F=20.67,P<0.001).The geometric mean of homocysteine in the case group was 15.07 μmol/L,and there was no significant difference(t=0.53,P=0.60) between case group and control group(14.63 μmol/L) in this regard.There was no correlation between Hcy and acute cardiovascular and cerebrovascular events after further control of multiple confounding factors. [Conclusion] The relationship between Hcy and acute cardiovascular and cerebrovascular events is not very clear.Further study is needed.
引文
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[14]HUANG X,LI Y B,LI P,et al.Association between percent decline in serum total homocysteine and risk of first stroke[J].Neurology,2017,89(20):2101-2107.
[15]赵庆霞,卢峰,纪征,等.H型高血压与急性心肌梗死的相关性[J].中华高血压杂志,2011,19(2):139-142.
[16]PENG H Y,MAN C F,XU J,et al.Elevated homocysteine levels and risk of cardiovascular and all-cause mortality:a meta-analysis of prospective studies[J].J Zhejiang Univ Sci B,2015,16(1):78-86.
[17]FOLSOM A R,NIETO F J,MCGOVERN P G,et al.Prospective study of coronary heart disease incidence in relation to fasting total homocysteine,related genetic polymorphisms,and B vitamins:the Atherosclerosis Risk in Communities (ARIC) study[J].Circulation,1998,98(3):204-210.
[18]TUCKER K L,OLSON B,BAKUN P,et al.Breakfast cereal fortified with folic acid,vitamin B-6,and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations:a randomized trial[J].Am J Clin Nutr,2004,79(5):805-811.
[2]WHO.World Health Statistics 2012[EB/OL].[2018-05-15].http://www.who.int/gho.
[3]McCULLY K S.Homocysteine and the pathogenesis of atherosclerosis[J].Expert Rev Clin Pharmacol,2015,8(2):211-219.
[4]王伟,王娜,王云辉,等.上海某社区35～59岁高血压人群同型半胱氨酸水平及其分布特征[J].上海预防医学,2018,30(5):340-345.
[5]穆银玉,谢服役,黄春蕾.宁波地区49079例同型半胱氨酸检测结果分析[J].上海预防医学,2016,28(8):568-569.
[6]孔灵芝.慢性非传染性疾病流行现状、发展趋势及防治策略[J].中国慢性病预防与控制,2002,10(1):1-2,19.
[7]吴亚哲,陈伟伟.中国脑卒中流行概况[J].心脑血管病防治,2016,16(6):410-414.
[8]TOWFIGHI A,MARKOVIC D,OVBIAGELE B.Pronounced association of elevated serum homocysteine with stroke in subgroups of individuals:a nationwide study[J].J Neurol Sci,2010,298(1-2):153-157.
[9]GALAN P,KESSE-GUYOT E,CZEMICHOW S,et al.Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases:a randomised placebo controlled trial[J].BMJ,2010,341:c6273.
[10]柴文,吴晓牧,曹文锋,等.血浆同型半胱氨酸与脑梗死的相关性[J].中华脑血管病杂志(电子版),2011,5(5):362-366.
[11]LIU H,YANG M,LI G M,et al.The MTHFR C677T polymorphism contributes to an increased risk for vascular dementia:a meta-analysis[J].J Neurol Sci,2010,294(1-2):74-80.
[12]张岩,霍勇.伴同型半胱氨酸升高的高血压——“H型”高血压[J].心血管病学进展,2011,32(1):3-6.
[13]马剑平,陈忠伟,陈思韩,等.高血压患者同型半胱氨酸与卒中关系的前瞻性研究[J].中华内科杂志,2015,54(4):296-301.
[14]HUANG X,LI Y B,LI P,et al.Association between percent decline in serum total homocysteine and risk of first stroke[J].Neurology,2017,89(20):2101-2107.
[15]赵庆霞,卢峰,纪征,等.H型高血压与急性心肌梗死的相关性[J].中华高血压杂志,2011,19(2):139-142.
[16]PENG H Y,MAN C F,XU J,et al.Elevated homocysteine levels and risk of cardiovascular and all-cause mortality:a meta-analysis of prospective studies[J].J Zhejiang Univ Sci B,2015,16(1):78-86.
[17]FOLSOM A R,NIETO F J,MCGOVERN P G,et al.Prospective study of coronary heart disease incidence in relation to fasting total homocysteine,related genetic polymorphisms,and B vitamins:the Atherosclerosis Risk in Communities (ARIC) study[J].Circulation,1998,98(3):204-210.
[18]TUCKER K L,OLSON B,BAKUN P,et al.Breakfast cereal fortified with folic acid,vitamin B-6,and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations:a randomized trial[J].Am J Clin Nutr,2004,79(5):805-811.