|
|
同型半胱氨酸与脑白质病变关系的Meta分析
|
Abstract:
目的：系统评价血浆同型半胱氨酸水平与脑白质病变的关系。方法：计算机检索PubMed、Embase、Cochrane、CNKI和万方数据库自建库至2023年10月有关同型半胱氨酸与脑白质病变的文献。由2名研究者按照纳入和排除标准进行文献筛选、资料提取和质量评价后，采用Revman5.4和stata16软件进行数据分析。结果：共纳入10篇病例对照研究。纳入的10篇文献的纽卡斯尔–渥太华量表(NOS)评分均 ≥ 6分，表明质量可靠。meta分析结果显示，血浆同型半胱氨酸水平与脑白质病变相关(轻度vs.对照组：MD = 1.23, 95% CI: 0.91~1.55；中度vs.对照组：MD = 3.44, 95% CI: 2.65~4.22；重度组vs.对照组：MD = 6.46, 95% CI: 4.69~8.24)。且血浆同型半胱氨酸水平与脑白质病变严重程度呈显著正相关(中度vs.轻度：MD = 2.01, 95% CI: 1.62~2.40；重度vs.轻度：MD = 5.00, 95% CI: 3.34~6.65；重度vs.中度：MD = 2.99, 95% CI: 1.48~4.49)。结论：血浆同型半胱氨酸水平越高，脑白质病变程度越严重。
Objective: To systematically evaluate the relationship between homocysteine level and the severity of white matter lesions. Methods: PubMed, Embase, Cochrane, CNKI and Wanfang database were searched by computer from the establishment of the database to October 2023 to find literatures on homocysteine and white matter lesions. After literature selection, data extraction and quality evaluation according to the inclusion and exclusion criteria by two researchers, Revman 5.4 and stata 16 software were used to analyze the data. Results: A total of 10 case-control studies were included. The Newcastle-Ottawa Scale (NOS) scores of the 10 included studies were all above 6 points, indicating that the quality was reliable. Meta-analysis results showed that homocysteine level was correlated with white matter lesions (mild vs. control group: MD = 1.23, 95% CI: 0.91~1.55; moderate vs. control group: MD = 3.44, 95% CI: 2.65~4.22; severe vs. control group: MD = 6.46, 95% CI: 4.69~8.24). There was a significant positive correlation between homocysteine level and severity of white matter lesions (moderate vs. mild: MD = 2.01, 95% CI: 1.62~2.40; severe vs. mild: MD = 5.00, 95% CI: 3.34~6.65; severe vs. moderate: MD = 2.99, 95% CI: 1.48~4.49). Conclusions: The higher the level of homocysteine, the higher the severity of white matter lesions.
| [1] | Wardlaw, J.M., Smith, C. and Dichgans, M. (2019) Small Vessel Disease: Mechanisms and Clinical Implications. The Lancet Neurology, 18, 684-696. https://doi.org/10.1016/S1474-4422(19)30079-1 |
| [2] | Litak, J., Mazurek, M., Kulesza, B., et al. (2020) Cerebral Small Vessel Disease. International Journal of Molecular Sciences, 21, Article 9729. https://doi.org/10.3390/ijms21249729 |
| [3] | 赵梦娇, 赵玉华. 脑小血管病的流行病学概况[J]. 西藏医药, 2018, 39(6): 143-145. |
| [4] | 徐群. 脑小血管病的研究进展[J]. 老年医学与保健, 2022, 28(5): 961-963. |
| [5] | Cannistraro, R.J., Badi, M., Eidelman, B.H., et al. (2019) CNS Small Vessel Disease: A Clinical Review. Neurology, 92, 1146-1156. https://doi.org/10.1212/WNL.0000000000007654 |
| [6] | Giese, A.-K., Schirmer, M.D., Dalca, A.V., et al. (2020) White Matter Hyperintensity Burden in Acute Stroke Patients Differs by Ischemic Stroke Subtype. Neurology, 95, e79-e88. |
| [7] | Fazekas, F., Chawluk, J.B., Alavi, A., et al. (1987) MR Signal Abnormalities at 1.5 T in Alzheimer’s Dementia and Normal Aging. AJR: American Journal of Roentgenology, 149, 351-356. https://doi.org/10.2214/ajr.149.2.351 |
| [8] | Jiang, J., Gao, Y., Zhang, R., et al. (2021) Differential Effects of Serum Lipoprotein-Associated Phospholipase A2 on Periventricular and Deep Subcortical White Matter Hyperintensity in Brain. Frontiers in Neurology, 12, Article 605372. https://doi.org/10.3389/fneur.2021.605372 |
| [9] | 潘希娟, 邢英琦, 刘玉梅. 脑小血管病影像学评分方法[J]. 中国现代神经疾病杂志, 2023, 23(7): 633-637. |
| [10] | 孔娟. 高同型半胱氨酸血症诊疗专家共识[J]. 肿瘤代谢与营养电子杂志, 2020, 7(3): 283-288. |
| [11] | Djuric, D., Jakovljevic, V., Zivkovic, V., et al. (2018) Homocysteine and Homocysteine-Related Compounds: An Overview of the Roles in the Pathology of the Cardiovascular and Nervous Systems. Canadian Journal of Physiology and Pharmacology, 96, 991-1003. https://doi.org/10.1139/cjpp-2018-0112 |
| [12] | Moller, J., Nielsen, G.M., Tvedegaard, K.C., et al. (2000) A Meta-Analysis of Cerebrovascular Disease and Hyperhomocysteinaemia. Scandinavian Journal of Clinical and Laboratory Investigation, 60, 491-500. https://doi.org/10.1080/003655100448473 |
| [13] | Hozo, S.P., Djulbegovic, B. and Hozo, I. (2005) Estimating the Mean and Variance from the Median, Range, and the Size of a Sample. BMC Medical Research Methodology, 5, Article No. 13. https://doi.org/10.1186/1471-2288-5-13 |
| [14] | McGrath, S., Zhao, X., Steele, R., et al. (2020) Estimating the Sample Mean and Standard Deviation from Commonly Reported Quantiles in Meta-Analysis. Statistical Methods in Medical Research, 29, 2520-2537. https://doi.org/10.1177/0962280219889080 |
| [15] | Ba, H.M., Hou, Y.T., Yang, M., et al. (2021) A Clinical Study of the Association between White Matter Hyperintensity, Aspirin Therapy and Cerebral Microbleeds. Chinese Journal of Contemporary Neurology and Neurosurgery, 21, 861-868. |
| [16] | 刘柯婷, 贺泽民, 杨百元, 等. 同型半胱氨酸水平与脑白质病变严重程度的相关性研究[J]. 南通大学学报(医学版), 2023, 43(5): 439-443. |
| [17] | 周佳. 同型半胱氨酸与脑白质病变及认知功能的相关性研究[D]: [硕士学位论文]. 沈阳: 中国医科大学, 2020. |
| [18] | 杨光, 徐陈陈, 王佳炜, 等. 帕金森病患者血清同型半胱氨酸及血脂水平与脑白质病变的相关性研究[J]. 中华全科医学, 2021, 19(9): 1451-1454. |
| [19] | 王玉, 刘强. 脑白质病变与脑小血管病患者认知功能障碍的相关性研究[J]. 中国医学工程, 2022, 30(11): 19-24. |
| [20] | 薛慧, 彭小妍, 程程, 等. 老年2型糖尿病患者缺血性脑白质病变严重程度的危险因素分析[J]. 中国实用神经疾病杂志, 2021, 24(13): 1140-1146. |
| [21] | 赵冯主. 脑白质疏松与老年抑郁的相关性研究[D]: [硕士学位论文]. 大连: 大连医科大学, 2018. |
| [22] | 赵继来, 胡玲玲, 刘勇, 等. 脑小血管病中脑白质病变严重程度的影响因素及其与阻塞性睡眠呼吸暂停低通气综合征的相关性研究[J]. 中国血液流变学杂志, 2022, 32(2): 217-221. |
| [23] | 闫少净, 朴翔宇, 赵洁, 等. 血清基质金属蛋白酶-2在脑白质病变患者头颅MRI各分级中的表达水平[J]. 临床神经病学杂志, 2017, 30(6): 435-438. |
| [24] | 韩洪伟. 脑小血管病相关脑白质病变Fazekas分级影响因素及其与认知障碍的相关性分析[D]: [硕士学位论文]. 南昌: 南昌大学, 2023. |
| [25] | Xu, L., Zhang, H., Wang, Y., et al. (2022) FABP4 Activates the JAK2/STAT2 Pathway via Rap1a in the Homocysteine-Induced Macrophage Inflammatory Response in ApoE？/？ Mice Atherosclerosis. Laboratory Investigation, 102, 25-37. https://doi.org/10.1038/s41374-021-00679-2 |
| [26] | Lai, W.K.C. and Kan, M.Y. (2015) Homocysteine-Induced Endothelial Dysfunction. Annals of Nutrition & Metabolism, 67, 1-12. https://doi.org/10.1159/000437098 |
| [27] | 郭会艳. 脑梗死患者D二聚体与血清同型半胱氨酸水平变化及检测的临床意义[J]. 临床检验杂志(电子版), 2019, 8(3): 170. |
| [28] | Small, G.W. (1985) Revised Ischemic Score for Diagnosing Multi-Infarct Dementia. Journal of Clinical Psychiatry, 46, 514-517. |
| [29] | 梁燕, 章军建. 脑卒中与白质病变[J]. 神经损伤与功能重建, 2014, 9(6): 512-514. |
| [30] | Esse, R., Barroso, M., Tavares, D.A.I., et al. (2019) The Contribution of Homocysteine Metabolism Disruption to Endothelial Dysfunction: State-of-the-Art. International Journal of Molecular Sciences, 20, Article 867. https://doi.org/10.3390/ijms20040867 |
| [31] | Silla, Y., Varshney, S., Ray, A., et al. (2019) Hydrolysis of Homocysteine Thiolactone Results in the Formation of Protein-Cys-S-S-Homocysteinylation. Proteins: Structure, Function, and Bioinformatics, 87, 625-634. https://doi.org/10.1002/prot.25681 |
| [32] | Kaplan, P., Tatarkova, Z., Sivonova, M.K., et al. (2020) Homocysteine and Mitochondria in Cardiovascular and Cerebrovascular Systems. International Journal of Molecular Sciences, 21, Article 7698. https://doi.org/10.3390/ijms21207698 |
