TyG指数、Hcy及叶酸代谢基因多态性与脑卒中的相关性

doi:10.3760/cma.j.cn441417-20240929-04029

摘要/Abstract

摘要：

目的　探讨外周血甘油三脂葡萄糖（TyG）指数、血清同型半胱氨酸（Hcy）及叶酸代谢基因多态性与脑卒中的相关性。方法　采用病例对照研究，选取西安中医脑病医院2022年2月至2024年2月收治的脑卒中患者95例作为研究组，男49例、女46例，年龄（59.96±4.92）岁，另外按照1∶1选取于本院同期接受健康体检的健康人群95名作为对照组，男51例、女44例，年龄（59.95±4.85）岁。收集两组研究对象的临床资料，并检测外周血TyG指数、血清Hcy水平及叶酸代谢基因多态性，同时分析脑卒中发病的危险因素。统计学方法采用独立样本t检验、χ²检验、单因素分析、logistic回归分析和Hardy-Weinburg平衡检验。结果　研究组体重指数（BMI）≥28 kg/m²、高血脂、糖尿病、高血压、饮酒史、吸烟史占比及外周血TyG指数、血清Hcy水平均高于对照组［24.21%（23/95）比7.37%（7/95）、25.26%（24/95）比9.47%（9/95）、21.05%（20/95）比8.42%（8/95）、48.42%（46/95）比16.84%（16/95）、23.16%（22/95）比9.47%（9/95）、28.42%（27/95）比11.58%（11/95）、1.67±0.44比1.03±0.25、（25.54±6.79）μmol/L比（10.22±2.16）μmol/L］，差异均有统计学意义（均P<0.05）。研究组5，10-亚甲基四氢叶酸还原酶（MTHFR）C677T位点TT基因型、甲硫氨酸合成酶还原酶（MTRR）A66G位点GG基因型频率［42.11%（40/95）、38.95%（37/95）］高于对照组［14.74%（14/95）、18.95%（18/95）］，差异均有统计学意义（均P<0.05）。Logistic回归分析结果显示，高血脂（OR=1.627）、糖尿病（OR=1.659）、高血压（OR=1.706）、饮酒史（OR=1.637）、吸烟史（OR=1.455）、外周血TyG指数偏高（OR=1.510）、血清Hcy水平偏高（OR=1.820）及MTHFR C677T位点TT基因型（OR=1.799）均是脑卒中发病的独立危险因素（均P<0.05）。结论　脑卒中与外周血TyG指数、血清Hcy水平偏高及MTHFR C677T位点TT基因型密切相关。

关键词:

脑卒中, 甘油三脂葡萄糖指数, 同型半胱氨酸, 叶酸, 基因多态性

Abstract:

Objective　To investigate the correlation of peripheral blood triglyceride glucose (TyG) index, serum homocysteine (Hcy), and folate metabolism genes with stroke. Methods　This was a case control study. Ninety-five patients with stroke treated at Xi'an Hospital of Traditional Chinese Medicine and Cerebral Diseases from February 2022 to February 2024 were selected as a study group, including 49 males and 46 females who were (59.96±4.92) years old. Ninety-five healthy examinees at Xi'an Hospital of Traditional Chinese Medicine and Cerebral Diseases in the same period were selected as a control group according to the ratio of 1:1, including 51 males and 44 females who were (59.95±4.85) years old. The clinical data of the two groups were collected. The peripheral blood TyG index, serum level of Hcy, and folate metabolism gene polymorphisms were detected. The risk factors for the development of stroke were analyzed. The statistical methods used were independent samples t test, χ² test, one-way analysis of variance, logistic regression analysis, and Hardy-Weinburg balance test. Results　The proportions of the patients with body mass index (BMI) ≥ 28 kg/m², hyperlipidemia, diabetes mellitus, hypertension, history of alcohol consumption, and smoking history, peripheral blood TyG index, and serum level of Hcy in the study group were higher than those in the control group [24.21% (23/95) vs. 7.37% (7/95), 25.26% (24/95) vs. 9.47% (9/95), 21.05% (20/95) vs. 8.42% (8/95), 48.42% (46/95) vs. 16.84% (16/95), 23.16% (22/95) vs. 9.47% (9/95), 28.42% (27/95) vs. 11.58% (11/95), 1.67±0.44 vs. 1.03±0.25, and (25.54±6.79) μmol/L vs. (10.22±2.16) μmol/L], with statistical differences (all P<0.05). The frequencies of TT genotype at MTHFR C677T locus and GG genotype at MTRR A66G locus in the study group were higher than those in the control group [42.11% (40/95) vs. 14.74% (14/95) and 38.95% (37/95) vs. 18.95% (18/95)], with statistical differences (both P<0.05). The logistic regression analysis showed that hyperlipidemia (OR=1.627), diabetes mellitus (OR=1.659), hypertension (OR=1.706), history of alcohol consumption (OR=1.637), history of smoking (OR=1.455), high peripheral blood TyG index (OR=1.510), high serum Hcy level (OR=1.820), and the TT genotype of the MTHFR C677T locus (OR=1.799) were the independent risk factors for the development of stroke (all P<0.05). Conclusion　Stroke is strongly associated with peripheral blood TyG index, high serum level of Hcy, and TT genotype at the MTHFR C677T locus.

Key words:

Stroke, Triglyceride-glucose index, Homocysteine, Folate, Gene polymorphisms

怡文辉王凯悦陈霄.

TyG指数、Hcy及叶酸代谢基因多态性与脑卒中的相关性 [J]. 国际医药卫生导报, 2025, 31(4): 674-679.

Yi Wenhui, Wang Kaiyue, Chen Xiao.

Correlation of TyG index, Hcy, and folate metabolism genes with stroke [J]. International Medicine and Health Guidance News, 2025, 31(4): 674-679.

参考文献

[1] 谭玉,张照婷,刘建华,等.急性脑梗死患者心脏功能和颅内外动脉血流动力学的临床研究[J].国际医药卫生导报,2022,28(9):1296-1301.DOI:10.3760/cma.j.issn.1007- 1245. 2022.09.026.
[2] Chidambaram SB, Rathipriya AG, Mahalakshmi AM, et al. The influence of gut dysbiosis in the pathogenesis and management of ischemic stroke[J]. Cells, 2022,11(7):1239. DOI: 10.3390/cells11071239.
[3] Potter TBH, Tannous J, Vahidy FS. A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke[J]. Curr Atheroscler Rep, 2022,24(12):939-948. DOI: 10.1007/s11883-022-01067-x.
[4] Perera KS, de Sa Boasquevisque D, Rao-Melacini P, et al. Evaluating rates of recurrent ischemic stroke among young adults with embolic stroke of undetermined source: the young ESUS longitudinal cohort study[J]. JAMA Neurol, 2022,79(5):450-458. DOI: 10.1001/jamaneurol.2022.0048.
[5] 曹志伟,刘倩,李静,等. 三酰甘油血糖指数纵向轨迹对新发心脑血管疾病的影响研究[J]. 中国全科医学,2022,25(5):554-560,657. DOI:10.12114/j.issn.1007-9572.2021. 01.320.
[6] 吴宇航,颜玮,徐艳,等. 高血压和高同型半胱氨酸与脑卒中相关性分析[J]. 现代预防医学,2023,50(13):2319-2325. DOI:10.20043/j.cnki.MPM.202210540.
[7] 李丹康,赵青林,张程达,等.一碳代谢相关基因多态性对叶酸治疗脑卒中患者高同型半胱氨酸血症疗效的影响[J].中国临床药理学杂志,2020,36(23):3892-3895.DOI:10.13699/j.cnki.1001-6821.2020.23.005.
[8] Zhang J, Zeng C, Huang X, et al. Association of homocysteine and polymorphism of methylenetetrahydrofolate reductase with early-onset post stroke depression[J]. Front Nutr, 2022,9:1078281. DOI: 10.3389/fnut.2022.1078281.
[9] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682. DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
[10] 杨建涵.泸州市在职体检者脑卒中高危人群筛查及其影响因素分析[D].泸州:西南医科大学,2022.DOI:10.27215/d.cnki.glzyu.2022.000257.
[11] Field TS, Sposato LA, Hill MD, et al. Embolic stroke of undetermined source: current perspectives on diagnosis, investigations, and management[J]. Can J Cardiol, 2023,39(2):172-186. DOI: 10.1016/j.cjca.2022.10.017.
[12] 高姣,马丽,张楠,等. 西安市老年体检人群脑卒中发病风险水平及危险因素研究[J]. 华南预防医学,2023,49(1):72-74,78. DOI:10.12183/j.scjpm.2023.0072.
[13] 王永华,王春玉. 河南豫东地区乡镇居民脑卒中的流行病学特征及高危因素分析[J]. 卒中与神经疾病,2020,27(4):466-469,478. DOI:10.3969/j.issn.1007-0478.2020. 04.0010.
[14] 那布其,张星光,乔丽颖,等. 内蒙古居民缺血性脑卒中发病影响因素研究[J]. 中国慢性病预防与控制,2023,31(9):680-684. DOI:10.16386/j.cjpccd.issn.1004-6194.2023. 09.009.
[15] 李珩娜,闫福岭. 脑卒中后疲劳的发病机制、危险因素及治疗研究进展[J]. 中华神经医学杂志,2022,21(10):1073-1077. DOI:10.3760/cma.j.cn115354-20220624- 00445.
[16] 朱帅,张一英,向芳,等. 脑卒中高危人群缺血性脑卒中3年发病影响因素COX回归分析[J]. 中国慢性病预防与控制,2022,30(2):134-137. DOI:10.16386/j.cjpccd.issn.1004-6194.2022.02.012.
[17] Ismail M, Mok VC, Wong A, et al. Risk factors for delayed-onset dementia after stroke or transient ischemic attack-a five-year longitudinal cohort study[J]. Int J Stroke, 2022,17(5):517-525. DOI: 10.1177/17474930211026519.
[18] 廖灿林. 甘油三酯--葡萄糖指数与脑卒中发病率的相关性研究[D]. 汕头: 汕头大学, 2023.
[19] 方奎,张晶,朱晨,等. 三酰甘油-葡萄糖指数(TyG)与中老年人新发脑卒中风险的关联性研究[J]. 公共卫生与预防医学,2024,35(4):37-40. DOI:10.3969/j.issn.1006-2483. 2024.04.009.
[20] 谢翼,曹亚军,姬燕,等. 三酰甘油葡萄糖乘积指数对短暂性脑缺血发作患者近期脑卒中风险的预测价值[J]. 中国医药,2022,17(1):54-58. DOI:10.3760/j.issn.1673-4777. 2022.01.013.
[21] 王晓雯,肖统领,王祎,等. 急性缺血性脑卒中患者同型半胱氨酸水平与急性肾损伤的关系研究[J]. 中国全科医学,2023,26(26):3290-3296. DOI:10.12114/j.issn.1007- 9572.2022.0899.
[22] 张鸥,刘洋,蒙航娟,等. 血浆同型半胱氨酸水平与脑卒中关系研究进展[J]. 中国公共卫生,2021,37(12):1840-1844. DOI:10.11847/zgggws1127767.
[23] Du X, Xiao L, Sun R, et al. A prospective cohort study of MTHFR C677T gene polymorphism and its influence on the therapeutic effect of homocysteine in stroke patients with hyperhomocysteinemia[J]. BMC Neurol, 2020,20(1):128. DOI: 10.1186/s12883-020-01701-8.
[24] Brisson RT, Arruda JFL, Silva LD, et al. Stroke in young military men with heterozygous for MTHFR gene mutation or factor V Leiden gene mutation associated with patent foramen ovale: report of two cases and therapeutic strategy[J]. Mil Med, 2023,188(3-4):e885-e889. DOI: 10.1093/milmed/usab192.
[25] 石丽丽,李岩,毛宏梅,等. 基因多态性在叶酸干预心脑血管疾病中的作用[J]. 卫生研究,2023,52(4):648-656. DOI:10.19813/j.cnki.weishengyanjiu.2023.04.023.