血清同型半胱氨酸水平影响接受静脉溶栓治疗的年轻急性缺血性脑卒中患者的功能结局

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-07-02 DOI:10.1016/j.jocn.2025.111420

Chengfeng Xing , Huawei Su , Wenxin Xie , Jijun Teng , Liang Zhang , Lijun Liu

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引用次数: 0

摘要

目的探讨年龄对急性缺血性脑卒中（AIS）患者接受静脉溶栓治疗3个月时血清同型半胱氨酸（Hcy）水平与功能预后之间关系的影响。方法回顾性分析240例连续接受静脉溶栓治疗的AIS患者的资料，并在AIS后3个月进行随访。采用多变量logistic回归模型的似然比检验来评估年龄和血清Hcy水平对这些患者3个月功能结局的潜在相互作用。随后，我们进行了年龄分层的多变量logistic回归分析，以检查不同年龄组血清Hcy浓度与3个月不良结局之间的差异关联。结果研究队列包括175例男性患者（72.92%）和65例女性患者，中位年龄64岁。在3个月的随访期间，59例患者（24.58%）出现了不良的功能结局。结果不良的患者血清Hcy水平明显高于结果良好的患者(中位数：16.00 μmol/L vs. 10.60 μmol/L, P <；0.001)。值得注意的是，年龄和血清Hcy水平对接受静脉溶栓治疗的AIS患者3个月不良结局存在显著的交互作用（交互作用P = 0.014）。多变量调整后，血清Hcy水平升高与3个月的不良结局独立相关，特别是在静脉溶栓治疗的AIS患者中。64年(OR = 1.424, 95% CI -1.683 = 1.204, P & lt;0.001)，而在≥64岁的患者中，这种关联无统计学意义（OR = 1.132, 95% CI = 0.997-1.284, P = 0.056）。结论血清Hcy水平升高对接受静脉溶栓治疗的AIS患者3个月功能预后具有年龄依赖的预后意义，可作为年轻患者不良预后的独立预测因子。需要进一步的研究来验证这种年龄分层效应，并阐明其潜在的病理生理机制。

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Serum homocysteine levels affect functional outcomes in younger acute ischemic stroke patients receiving intravenous thrombolysis

Objective

The study explores the effect of age on the association between serum homocysteine (Hcy) levels and functional outcomes at 3 months in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.

Methods

We retrospectively analyzed data from 240 consecutive AIS patients who underwent intravenous thrombolysis and were followed-up at 3 months post-AIS. The likelihood ratio test in the multivariable logistic regression model was performed to evaluate the potential interaction between age and serum Hcy levels on 3-month functional outcomes in these patients. Subsequently, we conducted age-stratified multivariable logistic regression analyses to examine the differential associations between serum Hcy concentrations and 3-month adverse outcomes across distinct age groups.

Results

The study cohort consisted of 175 male patients (72.92 %) and 65 female patients, with a median age of 64 years. During the 3-month follow-up period, 59 patients (24.58 %) experienced unfavorable functional outcomes. Patients with unfavorable outcomes had significantly higher serum Hcy levels compared to those with favorable outcomes (median: 16.00 μmol/L vs. 10.60 μmol/L, P < 0.001). Notably, a significant interaction effect between age and serum Hcy levels was identified for 3-month adverse outcomes in AIS patients receiving intravenous thrombolysis (P for interaction = 0.014). After multivariable adjustment, elevated serum Hcy levels were independently associated with 3-month unfavorable outcomes specifically in intravenous thrombolysis-treated AIS patients aged < 64 years (OR = 1.424, 95 % CI = 1.204–1.683, P < 0.001), whereas this association was not statistically significant in patients aged ≥ 64 years (OR = 1.132, 95 % CI = 0.997–1.284, P = 0.056).

Conclusions

Elevated serum Hcy levels demonstrate age-dependent prognostic significance for 3-month functional outcomes in AIS patients receiving intravenous thrombolysis, acting as an independent predictor of unfavorable outcomes exclusively in younger patients. Further research is warranted to validate this age-stratified effect and to elucidate the underlying pathophysiological mechanisms.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.