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标题：Changes in total homocysteine levels after acute stroke and recurrence of stroke
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作者：Zhihong Shi ; Shuling Liu ; Yalin Guan 等
期刊名称：Scientific Reports
电子版ISSN：2045-2322
出版年度：2018
卷号：8
期号：1
页码：6993
DOI：10.1038/s41598-018-25398-5
语种：English
出版社：Springer Nature
摘要：It is not known how total homocysteine (tHcy) levels change during the transition from acute stroke to post-stroke convalescence or whether tHcy changes occurring after the acute period are associated with recurrence of cerebro-cardiovascular events. Levels of tHcy were measured during acute ischemia and again after three months. Patients were followed for a median of 18 (range: 12-36) months. A total of 2800 patients who had at least two tHcy measurements were enrolled between February 2012 and June 2014; 2587 patients presented with ischemic stroke and 213 presented with cerebral hemorrhage. During the follow-up period, 220 (7.9%) patients experienced another ischemic event. After adjusting for additional cardiovascular risk factors, patients with the highest levels of tHcy (fourth quartile; >15.5 μmol/L) had a 1.76-fold increased risk of a recurrence (adjusted HR: 1.76, 95%CI: 1.11-3.08) as compared to patients with the lowest levels of tHcy (lowest quartile; ≤9.65 μmol/L). Additional analysis by subgroup indicated that this correlation was only significant for patients with large-artery atherosclerosis ischemia (adjusted HR: 2.00, 95%CI: 1.13-3.55). Elevated tHcy during the convalescent phase of acute stroke was independently associated with an increased risk of recurrent ischemic stroke, especially in those patients with large-vessel atherosclerosis ischemia.