摘要
目的探讨急性动脉粥样硬化性缺血性脑卒中(Ischemic stroke,IS)患者同型半胱氨酸(Homocysteine,Hcy与β2-微球蛋白(β2-microglobulin,β2-MG)的相关性。方法回顾性纳入2019年12月~2021年12月我院神经内科收治的动脉粥样硬化性IS患者371例,根据发病时间分为急性期IS组(232例)和非急性期IS组(139例),再根据急性期IS组所有患者的血浆Hcy四分位数水平,分为Q1组(Hcy<14.33μmol/L)、Q2组(Hcy 14.33~18.05μmol/L)、Q3组(Hcy18.06~23.88μmol/L)和Q4组(Hcy>23.88μmol/L);并以血浆Hcy中位数水平进行分组,即合并Q1组、Q2组为Q1-2亚组,Q3组、Q4组为Q3-4亚组。比较急性期IS组和非急性期IS组及各亚组间临床资料的差异。以血浆Hcy为因变量,将经Spearman相关性分析和Logistic回归共线性检验及变量筛选后的相关自变量纳入多因素Logistic回归分析。结果急性期IS组患者血浆Hcy水平高于非急性期IS组,差异具有统计学意义(Z=-4.248,P<0.01)。在以血浆Hcy四分位数水平分组的各亚组比较中,血浆Hcy水平较高的患者整体年龄更大,男性比例更高,且吸烟比例也呈升高趋势;但患有糖尿病和使用降糖药物患者比例均较低(P<0.05)。血浆Hcy水平较高患者血清β2-MG水平也较高(P<0.01)。即使在正常临床参考值范围内,随着血浆Hcy水平升高,血肌酐(Creatinine,Cr)、血尿酸(Uric acid,UA)水平呈升高趋势;估算的肾小球滤过率(Estimated glomerular filtration rate,eGFR)水平则呈降低趋势(P<0.05)。多因素Logistic回归分析显示,血浆Hcy水平升高(在Q2和Q3亚组)与性别(男性)独立相关(P<0.05),血浆Hcy水平升高(在Q3和Q4亚组)与血清β2-MG水平升高独立相关(P<0.05)。在以血浆Hcy中位数水平分组的两亚组比较中,Q3-4亚组男性患者比例更高(P<0.05),且血清β2-MG水平也更高(Z=-4.969,P<0.01)。多因素Logistic回归(向前法)分析显示,血浆Hcy水平升高与性别(男性)[OR=2.529,95%CI(1.367~4.679),P=0.003]、血清β2-MG水平�
Objective To investigate the correlation between homocysteine(Hcy)andβ2-microglobulin(β2-MG in patients with acute atherosclerotic ischemic stroke(IS).Methods A total of 371 patients with atherosclerotic IS admitted to the department of neurology of our hospital from Dec 2019 to Dec 2021 were retrospectively included.According to the time of onset,the patients were divided into acute phase IS group(232 cases)and non-acute phase IS group(139 cases).According to the quartile levels of plasma Hcy,patients in the acute phase IS group were divided into Q1 group(Hcy<14.33μmol/L),Q2 group(Hcy 14.33~18.05μmol/L),Q3 group(Hcy 18.06~23.88μmol/L)and Q4group(Hcy>23.88μmol/L).After that,based on the median level of plasma Hcy,the combined Q1 and Q2 were the Q1-2 subgroup,the combined Q3 and Q4 were the Q3-4 subgroup.The differences in clinical data between the acute phase IS group and the non-acute phase IS group,and among the subgroups were compared.The relevant independent variables after Spearman correlation analysis and Logistic regression collinearity test and variable filter were included in multivariate Logistic regression analysis,with plasma Hcy as the dependent variable.Results The plasma Hcy level in the acute phase IS group was higher than that in the non-acute phase IS group,and the difference was statistically significant(Z=-4.248,P<0.01).In the subgroups comparison of plasma Hcy quartile levels,patients with higher plasma Hcy levels were older overall,had a higher proportion of males,and had an increased trend of smoking.However,they had lower rates of diabetes and use of hypoglycemic drugs(P<0.05).Patients with higher plasma Hcy levels also had higher serumβ2-MG levels(P<0.01).Even within the normal clinical reference value range,as the plasma Hcy levels increased,the serum creatinine(Cr)levels and the serum uric acid(UA)levels increased,the estimated glomerular filtration rate(eGFR)levels decreased(P<0.05).Multivariate Logistic regression analysis showed that elevated plasma Hcy levels(in the Q2 and Q3
作者
张英杰
邵少举
但美伶
仇慧慧
郭爱斌
张志英
尹榕
Zhang Yingjie;Shao Shaoju;Dan Meiling(Department of Neurology,the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army,Lanzhou 730050)
出处
《中国现代医药杂志》
2023年第2期1-8,共8页
Modern Medicine Journal of China
基金
军事医学创新工程项目(编号:19SWAQ13)。