Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack.
Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack.
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急性缺血性脑卒中和短暂性脑缺血发作患者同型半胱氨酸与炎症和认知障碍的关系
DOI：
10.2147/ndt.s333753
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发表时间：
2021
影响因子：
3.2
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Cui L;Lu P;Li S;Pan Y;Wang M;Li Z;Liao X;Wang Y
探讨急性缺血性卒中（AIS）和短暂性脑缺血发作（TIA）患者同型半胱氨酸（Hcy）、炎症和认知功能障碍的关系。纳入的患者来自中国国家卒中登记- iii （CNSR-III）的一个亚组。我们使用中文版的蒙特利尔认知评估（MoCA）来筛选认知障碍。我们使用高灵敏度c反应蛋白（hsCRP）水平来反映炎症状态，并在基线时与Hcy浓度一起评估。主要终点是AIS和TIA后3个月脑卒中后认知障碍（PSCI）的发生率。采用多变量logistic回归分析评价Hcy与hsCRP的相关性及其对认知的影响。我们招募了1466例患者，中位年龄为62岁（54-70岁），其中Hcy水平升高的患者895例（61.05%），hsCRP浓度升高的患者466例（31.79%），PSCI患者755例（51.50%）。在高同型半胱氨酸血症（HHcy）患者组中，无论是否校正多个潜在混杂因素，较高的hsCRP水平与认知障碍有关（粗or: 1.71,95% CI: 1.29-2.27, p < 0.01；校正or: 1.42, 95% CI: 1.04-1.93, p = 0.03）。在按年龄、性别分层的亚组或急性卒中治疗（TOAST）分级的Org 10172试验中，未观察到对PSCI影响的显著相互作用（P相互作用0.05）。高炎症水平增加了hcy患者在AIS和TIA后发生认知障碍的风险。
To investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition. We enrolled 1466 patients with a median age of 62 (54–70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29–2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04–1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all). High inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.