幽门螺杆菌感染及同型半胱氨酸与急性缺血性卒中短期结局的相关性研究

doi:10.3969/j.issn.1673-5765.2017.10.003

摘要/Abstract

摘要：

目的研究幽门螺杆菌（helicobacter pylori，Hp）感染及同型半胱氨酸（homocysteine，Hcy）与急性缺血性卒中（acute ischemic stroke，AIS）短期结局的相关性。方法采用前瞻性队列研究的方法，纳入唐山工人医院2014年1-12月的120例首发AIS患者。入院后测定Hp-IgG阳性率、Hcy水平，进行美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分，收集其他可能影响短期结局的相关因素（包括一般临床资料及生化指标）。对患者进行短期结局（发病2个月）改良Rankin量表（modified Rankin Scale，mRS）评分。结果 ①短期结局不良组的Hp感染率及Hcy水平显著高于结局良好组，比较差异具有显著性（P ＜0.05）。②以AIS短期结局为应变量，单因素Logistic回归分析发现，年龄、性别、基线NIHSS评分、Hp感染及Hcy水平与AIS患者短期结局相关。③以AIS短期结局为应变量，单因素分析中P＜0.05的因素为自变量，进行多因素Logistic回归分析，结果显示年龄[比值比（odds ratio，OR）=1.021，P =0.017]、基线NIHSS 评分（OR =2.318，P＜0.001）、Hp感染（OR =1.038，P =0.008）、Hcy（OR =1.029，P＜0.001）与AI S患者短期结局不良相关。结论 Hp感染、高Hcy血症是AIS患者短期结局不良的危险因素。

文章导读： 本研究发现结局不良组的幽门螺杆菌感染率及同型半胱氨酸水平高于结局良好组，幽门螺杆菌感染、高同型半胱氨酸血症是急性缺血性卒中患者短期结局不良的独立危险因素，从而为脑梗死的预防及治疗和评估预后提供帮助。

关键词: 急性缺血性卒中; 幽门螺杆菌; 同型半胱氨酸; 预后; 危险因素

Abstract:

Objective To study the relationship between Helicobacter pylori (Hp) infection, homocysteine (Hcy) and short-term outcome of acute ischemic stroke (AIS). Methods A prospective cohort study was conducted. A total of 120 patients with primaryacute ischemic stroke were enrolled in Tangshan Gongren hospital. The Hp-IgG and Hcy levels were measured, and the National Institutes of Health Stroke Scale (NIHSS) was performed after admission, and other related factors (including general clinical data and biochemical indexes) were collected. Modified Rankin Scale (mRS) at Month 2 after onset was performed when the patients were in admission and at discharge. Results (1) The Hp infection rate and the Hcy level of the poor-outcome group were higher than that in good-outcome group, and the difference was statistically significant (P <0.05). (2) Univariate logistic regression analysis showed that age, sex, NIHSS score, Hcy level and Hp infection were associated with short-term outcome of AIS patients. (3) Multivariate logistic regression showed age (OR =1.021, P =0.017), NIHSS Score (OR =2.318, P <0.001), Hp infection (OR =1.038, P =0.008), Hcy (OR=1.029, P <0.001) were correlated with short-term outcome of acute ischemic stroke. Conclusion Hp infection and elevated homocysteine level were the risk factors for short-term outcomes in patients with acute ischemic stroke.

Key words: Acute ischemic stroke; Helicobacter pylori; Homocysteine; Prognosis; Risk factors

刘舒，李永秋，夏立伟，赵明艳，李瑜霞，徐明，郭鑫，刘玉兰. 幽门螺杆菌感染及同型半胱氨酸与急性缺血性卒中短期结局的相关性研究[J]. 中国卒中杂志, 2017, 12(10): 895-899.

LIU Shu, LI Yong-Qiu, XIA Li-Wei, ZHAO Ming-Yan, LI Yu-Xia,XU Ming, GUO Xin, LIU Yu-Lan. The Study on Correlation between Helicobacter Pylori Infection, Homocysteine and Short-term Outcome of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2017, 12(10): 895-899.

参考文献

[1] BONITA R，MENDIS S，TRUELSEN T，et al. The

global stroke initiative[J]. Lancet Neurology，2004，3

（7）：391-393.

[2] 全国第四次脑血管病学术会议. 各类脑血管疾病诊

断要点[J]. 中华神经科杂志，1996，29（6）：379-380.

[3] BROTT T，MARLER J R，OLINGER C P，et al.

Measurements of acute cerebral infarction：lesion

size by computed tomography[J]. Stroke，1989，20

（7）：871-875.

[4] BONITA R，BEAGLEHOLE R. Recovery of motor

function after stroke[J]. Stroke，1988，19（12）：1497-

1500.

[5] 王云霄，袁俊亮，胡文立. 常用卒中量表的研究进展

[J]. 中国卒中杂志，2016，11（12）：1072-1077.

[6] 王东风，徐宁，赵杰，等. 老年人脑梗死和心肌梗死

与幽门螺旋杆菌感染的关系[J]. 中华老年医学杂志，

2001，20（1）：53.

[7] 储全兵. 幽门螺旋杆菌感染与脑卒中关系的临床研

究[J]. 临床神经病学杂志，2004，17（4）：296-297.

[8] GRAU A J，BUGGLE F，LICHY C，et al.

Helicobacter pylori infection as an independent risk

factor for cerebral ischemia of atherothrombotic

origin[J]. J Neurol Sci，2001，186（1-2）：1-5.

[9] VELDHUYZEN VAN ZANTEN S J，POLLAK

P T，BEST L M，et al. Increasing prevalence of

Helicobacter pylori Infection with age： continuous

risk of infection in adults rather than cohort effect[J].

J Infect Dis，1994，169（2）：434-437.

[10] 于海燕. 幽门螺杆菌感染与急性脑梗死关系的临床

研究[J]. 中国医药指南，2013，11（27）：375-376.

[11] 刘家琴，杜宝珠，汪晓. 脑梗塞患者炎性因子、血管

活性肽含量变化及相互关系的研究[J]. 临床内科杂

志，1999，16（1）：27-29.

[12] MEN X，LI J，ZHANG B，et al. Homocysteine

and C-reactive protein associated with progression

and prognosis of intracranial branch atheromatous

disease[J]. PloS One，2013，8（9）：e73030.

[13] GONG X，ZOU X，LIU L，et al. Prognostic value

of inflammatory mediators in 1-year outcome

of acute ischemic stroke with middle cerebral

artery stenosis[J]. Mediators Inflamm，2013，2013：

850714. doi: 10.1155/2013/850714. http://dx.doi.

org/10.1155/2013/850714.

[14] PNIEWSKI J，CHODAKOWSKA-ZEBROWSKA M，

WO?NIAK R，et al. Plasma homocysteine level and

the course of ischemic stroke[J]. Acta Neurobiol Exp

（Wars），2003，63（2）：127-130.

[15] KWON H M，LEE Y S，BAE H J，et al.

Homocysteine as a predictor of early neurological

deterioration in acute ischemic stroke[J]. Stroke，

2014，45（3）：871-873.

[16] OKUBADEJO N U，OLADIPO O O，

ADEYOMOYE A A，et al. Exploratory study of

plasma total homocysteine and its relationship

to short-term outcome in acute ischaemic stroke

in Nigerians[J]. BMC Neurol，2008，8：26. doi:

10.1186/1471-2377-8-26.

[17] HERNÁNDEZ-BETANCOR I，MARTÍN-PONCE

E，MARTÍNEZ-RIERA A，et al. Prognostic value

of serum homocysteine levels in elderly hospitalized

patients[J]. Nutr Hosp，2015，31（6）：2590-2597.

[18] SONG I U，KIM J S，RYU S Y，et al. Are plasma

homocysteine levels related to neurological severity

and functional outcome after ischemic stroke in the

Korean population?[J]. J Neurol Sci，2009，278（1-2）：

60-63.

[19] 邱忠明，桑红菲，徐格林. 2014年国际卒中大会概要

[J]. 国际脑血管病杂志，2014，22（4）：258-268.

[20] 曹红元，刘雨辉，李惠允，等. 急性脑梗死后炎症因

子的动态变化及其与神经功能的相关性研究[J]. 解

放军医药杂志，2014，26（3）：51-54.

[21] ZHONG C，LYU L，LIU C，et al. High

homocysteine and blood pressure related to poor

outcome of acute ischemia stroke in Chinese

population[J]. Plos One，2014，9（9）：e107498.

[22] 鞠丽英，冯玉光，张小茜，等. 幽门螺杆菌感染与血

清铁和维生素B12及叶酸的关系[J]. 现代医药卫生，

2012，28（12）：1772-1773.

[23] SARARI A S，FARRAJ M A，HAMOUDI W，et

al. Helicobacter pylori，a causative agent of vitamin

B12 deficiency[J]. J Infect in Dev Ctries，2008，2（5）：

346-349.