目的:本研究旨在确定和量化两者的相关性,并探讨血清维生素B12单独或维生素B12联合叶酸和血浆总同型半胱氨酸(tHcy)水平是否可用于预测急性缺血性卒中的风险。
方法:这项回顾性病例对照研究是在神经内科进行的,重庆医科大学附属第一医院.它包括259例首次急性缺血性卒中的住院患者和259例年龄匹配的患者,性别匹配的健康对照。根据中风的病因将患者分为几组:大动脉粥样硬化(LAAS,n=126),心脏栓塞(CEI,n=35),小血管疾病(SVD,n=89),其他确定病因的中风(ODE,n=5),和病因不明的中风(UDE,n=4)。血清维生素B12,叶酸,采用多变量logistic回归分析评价血浆tHcy水平与缺血性卒中风险的关系。受试者工作特征(ROC)曲线用于评估维生素B12、叶酸、缺血性卒中的tHcy水平。
结果:缺血性卒中患者的血清维生素B12和叶酸水平明显低于对照组,而血浆tHcy水平明显增高。血清维生素B12水平的第一个四分位数与LAAS风险增加显著相关(aOR=2.289,95%CI=1.098-4.770),SVD(aOR=4.471,95%CI=1.110-4.945)和整体缺血性卒中(aOR=3.216,95%CI=1.733-5.966)。同样,血清叶酸水平的第一个四分位数与LAAS风险增加相关(aOR=3.480,95%CI=1.954-6.449),CEI(aOR=2.809,95%CI=1.073-4.991),SVD(AOR=5.376,95%CI=1.708-6.924),和整体缺血性卒中(aOR=3.381,95%CI=1.535-7.449)。tHcy水平的第四个四分位数也与LAAS风险增加显著相关(aOR=2.946,95%CI=1.008-5.148),CEI(aOR=2.212,95%CI=1.247-5.946),SVD(AOR=2.957,95%CI=1.324-6.054),和整体缺血性卒中(aOR=2.233,95%CI=1.586-4.592)。预测不同类型的缺血性卒中,维生素B12单独显示出SVD的最佳诊断价值,灵敏度为71.0%,阴性预测值为90.3%,以及SVD的最高正似然比(+LR)。维生素B12+tHcy+叶酸对预测不同类型的缺血性卒中有价值,在SVD中观察到最显著的效果,其次是LAAS,和CEI中最弱的预测作用。此外,维生素B12单独结合其他指标,比如单独的叶酸,THcy独自一人,叶酸+tHcy可以降低负似然比(-LR),提高LR。
结论:维生素B12是急性缺血性卒中的独立危险因素。以维生素B12+tHcy+叶酸构建的风险计算模型对SVD的诊断价值最大。
OBJECTIVE: This study aimed to identify and quantify the association and investigate whether serum vitamin B12 alone or vitamin B12 combined with folate and plasma total homocysteine (tHcy) levels could be used to predict the risk of acute ischemic stroke.
METHODS: This retrospective case-control study was conducted in the Department of Neurology, First Affiliated Hospital of Chongqing Medical University. It included 259 inpatients experiencing their first-ever acute ischemic stroke and 259 age-matched, sex-matched healthy controls. Patients were categorized into groups based on the etiology of their stroke: large-artery atherosclerosis (LAAS, n = 126), cardio embolism (CEI, n = 35), small vessel disease (SVD, n = 89), stroke of other determined etiology (ODE, n = 5), and stroke of undetermined etiology (UDE, n = 4). The associations of serum vitamin B12, folate, and plasma tHcy levels with the risk of ischemic stroke were evaluated using multivariable logistic regression analysis. Receiver operator characteristic (ROC) curves were used to assess the diagnostic power of vitamin B12, folate, and tHcy levels for ischemic stroke.
RESULTS: Serum vitamin B12 and folate levels were significantly lower in ischemic stroke patients compared to controls, while plasma tHcy levels were significantly higher. The first quartile of serum vitamin B12 levels was significantly associated with an increased risk of LAAS (aOR = 2.289, 95% CI = 1.098-4.770), SVD (aOR = 4.471, 95% CI = 1.110-4.945) and overall ischemic stroke (aOR = 3.216, 95% CI = 1.733-5.966). Similarly, the first quartile of serum folate levels was associated with an increased risk of LAAS (aOR = 3.480, 95% CI = 1.954-6.449), CEI (aOR = 2.809, 95% CI = 1.073-4.991), SVD (aOR = 5.376, 95% CI = 1.708-6.924), and overall ischemic stroke (aOR = 3.381, 95% CI = 1.535-7.449). The fourth quartile of tHcy levels was also significantly associated with an increased risk of LAAS (aOR = 2.946, 95% CI = 1.008-5.148), CEI (aOR = 2.212, 95% CI = 1.247-5.946), SVD (aOR = 2.957, 95% CI = 1.324-6.054), and overall ischemic stroke (aOR = 2.233, 95% CI = 1.586-4.592). For predicting different types of ischemic stroke, vitamin B12 alone demonstrated the best diagnostic value for SVD, evidenced by a sensitivity of 71.0% and negative predictive value of 90.3%, along with the highest positive likelihood ratio (+ LR) for SVD. Vitamin B12 + tHcy + folate are valuable in predicting different types of ischemic stroke, with the most significant effect observed in SVD, followed by LAAS, and the weakest predictive effect in CEI. Additionally, vitamin B12 alone in combination with other indicators, such as folate alone, tHcy alone, and folate + tHcy could reduce negative likelihood ratio (-LR) and improve + LR.
CONCLUSIONS: Vitamin B12 was an independent risk factor for acute ischemic stroke. The risk calculation model constructed with vitamin B12 + tHcy + folate had the greatest diagnostic value for SVD.