Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients
Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients
复制标题
高同型半胱氨酸血症对缺血性脑卒中患者临床结局及溶栓后出血转化的影响
DOI：
10.3389/fneur.2019.00592
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发表时间：
2019-06-04
影响因子：
3.4
通讯作者：
Yang, Yi
中科院分区：
文献类型：
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作者：
Luo, Yun;Jin, Hang;Yang, Yi
背景和目的：高同型半胱氨酸血症（Hhcy）是缺血性脑卒中的一个众所周知的危险因素。然而，高同型半胱氨酸在缺血性脑卒中临床结局中的作用尚未完全阐明。此外，先前的研究发现，Hhcy与血脑屏障的破坏有关，这可能会增加溶栓后出血性转化（HT）的风险。因此，本研究的目的是探讨高同型半胱氨酸对缺血性脑卒中患者溶栓后临床结局和HT的影响。研究方法：本研究纳入了2016年1月至2018年9月期间诊断为缺血性卒中并接受静脉溶栓治疗的患者。多因素Logistic回归分析用于评估溶栓后高同型半胱氨酸、临床结局和高血压之间的关系。此外，还评估了Hhcy和高血压对溶栓后临床结局和HT的潜在相互作用。结果：568例患者中，455例（80.1%）患有Hhcy，66例（11.6%）患有HT，219例（38.6%）预后不良。Hhcy患者的不良结局发生率高于非Hhcy患者（40.9 vs. 29.2%，p = 0.022）。然而，Hhcy和非Hhcy患者之间HT的发生率无显著差异（11.9 vs. 10.6%，p = 0.711）。多因素Logistic回归分析显示，高同型半胱氨酸与预后不良风险增加独立相关（OR = 1.760，95%CI：1.069-2.896），与HT风险无关（OR = 1.017，95%CI：0.495-2.087）。此外，我们发现Hhcy和高血压之间没有显着的相互作用的临床结果（p = 0.513）或HT（p = 0.170）溶栓后。结论：我们发现，高同型半胱氨酸是缺血性卒中患者溶栓后不良结局的独立危险因素，但不是HT的独立危险因素。此外，高同型半胱氨酸和高血压对溶栓后的临床结局或HT没有显著的相互作用。
Background and Purpose: Hyperhomocysteinemia (Hhcy) is a well-known risk factor for ischemic stroke. However, the role of Hhcy in the clinical outcome of ischemic stroke has not been fully elucidated. In addition, previous studies have found that Hhcy was implicated in the disruption of the blood-brain barrier, which may increase the risk of hemorrhagic transformation (HT) after thrombolysis. Thus, the aim of this study was to investigate the effect of Hhcy on the clinical outcome and HT after thrombolysis in ischemic stroke patients. Methods: Patients who were diagnosed with ischemic stroke and received intravenous thrombolytic therapy between January 2016 and September 2018 were included in this study. Multivariate logistic regression analysis was used to assess the association between Hhcy, clinical outcome, and HT after thrombolysis. Furthermore, the potential interaction between Hhcy and hypertension on the clinical outcome and HT after thrombolysis was also assessed. Results: Of 568 patients, 455 (80.1%) had Hhcy, 66 (11.6%) had HT, and 219 (38.6%) had poor outcome. Patients with Hhcy had a higher incidence of poor outcome than the patients with non-Hhcy (40.9 vs. 29.2%, p = 0.022). However, there was no significant difference in the incidence of HT (11.9 vs. 10.6%, p = 0.711) between patients with Hhcy and non-Hhcy. After adjustment for major covariates, multivariate logistic regression analysis disclosed that Hhcy was independently associated with increased risk of poor outcome (OR = 1.760; 95% CI: 1.069–2.896) but was not associated with the risk of HT (OR = 1.017; 95% CI: 0.495–2.087). In addition, we found no significant interaction between Hhcy and hypertension on the clinical outcome (p = 0.513) or HT (p = 0.170) after thrombolysis. Conclusion: We found that Hhcy was an independent risk factor for poor outcome, but not an independent risk factor for HT after thrombolysis in ischemic stroke patients. In addition, there was no significant interaction of Hhcy and hypertension on the clinical outcome or HT after thrombolysis.