基于剂量反应分析评估血清同型半胱氨酸水平与老年急性缺血性脑卒中病人失眠的关系

doi:10.3969/j.issn.1003-9198.2025.10.012

摘要/Abstract

摘要： 目的探讨血清同型半胱氨酸(Hcy)水平与老年急性缺血性脑卒中(AIS)病人失眠的关系。方法选取2022年5月至2024年5月我院98例老年AIS病人,根据是否发生失眠分为失眠组(n=40)与非失眠组(n=58)。比较2组临床资料,采用多因素logistic回归分析老年AIS病人失眠相关因素,采用限制性立方样条模型分析Hcy水平与老年AIS病人失眠风险的关联强度。结果失眠组病人年龄、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分及血清Hcy水平均高于非失眠组病人(P＜0.05);多因素logistic回归分析显示,年龄、HAMA评分、HAMD评分及血清Hcy水平均为老年AIS病人失眠的独立影响因素(P＜0.05);限制性立方样条模型分析显示,血清Hcy水平与老年AIS病人失眠风险之间存在非线性剂量-反应关系(P＜0.05)。结论血清Hcy水平与老年AIS病人失眠风险之间存在非线性剂量-反应关系,监测病人Hcy水平,有助于早期识别并预防失眠,改善病人预后。

关键词: 急性缺血性脑卒中, 老年人, 失眠, 同型半胱氨酸, 剂量反应

Abstract: Objective To explore the relationship between serum homocysteine (Hcy) levels and insomnia in the elderly patients with acute ischemic stroke (AIS). Methods A total of 98 elderly patients with AIS in 981st Hospital of China People’s Liberation Army Joint Logistics Support Force from May 2022 to May 2024 were selected and divided into the insomnia group (n=40) and the non-insomnia group (n=58) based on whether insomnia occurred. The clinical data of the two groups were compared, and multiple logistic regression analysis was used to investigate the influencing factors for insomnia in the elderly AIS patients. Restricted cubic spline models were employed to analyze the association between Hcy level and the risk of insomnia in the elderly AIS patients. Results Age, scores of Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD) and serum Hcy level in the insomnia group were higher than those in the non-insomnia group (P<0.05). Multivariate logistic regression analysis showed that age, HAMA score, HAMD score and serum Hcy level were influencing factors for insomnia in the elderly AIS patients (P<0.05). Restricted cubic spline model analysis indicated a nonlinear dose-response relationship between serum Hcy level and the risk of insomnia in the elderly AIS patients (P<0.05). Conclusions There is a nonlinear dose-response relationship between serum Hcy level and the risk of insomnia in the elderly patients with AIS. Monitoring patients’ Hcy levels can help to identify and prevent insomnia early and improve patients’ prognosis.

Key words: acute ischemic stroke, aged, insomnia, homocysteine, dose-response

中图分类号:

R 743.3

李灵玲, 杨晓凤, 金钊, 赵宁, 郭晓玲, 张楠, 孙慧. 基于剂量反应分析评估血清同型半胱氨酸水平与老年急性缺血性脑卒中病人失眠的关系[J]. 实用老年医学, 2025, 39(10): 1028-1032.

LI Lingling, YANG Xiaofeng, JIN Zhao, ZHAO Ning, GUO Xiaoling, ZHANG Nan, SUN Hui. Relationship between serum homocysteine levels and insomnia based on dose-response analysis in elderly patients with acute ischemic stroke[J]. Practical Geriatrics, 2025, 39(10): 1028-1032.

参考文献

[1] RENÙ A, MILLÁN M, ROMÁN L S, et al. Effect of intra-arterial alteplase vs placebo following successful thrombectomy on functional outcomes in patients with large vessel occlusion acute ischemic stroke: the CHOICE randomized clinical trial[J]. JAMA, 2022, 327(9): 826-835.
[2] VÁCLAVÍK D, VOLNÝ O, CIMFLOVÁ P, et al. The importance of CT perfusion for diagnosis and treatment of ischemic stroke in anterior circulation[J]. J Integr Neurosci, 2022, 21(3): 92.
[3] LU Z, XIONG Y, FENG X, et al. Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients[J]. Cardiovasc Diabetol, 2023, 22(1): 225.
[4] ZHANG Z, WANG M, GILL D, et al. Genetically predicted sleep traits and functional outcome after ischemic stroke: a mendelian randomization study[J]. Neurology, 2023, 100(11): e1159-e1165.
[5] HUANG B H, DUNCAN M J, CISTULLI P A, et al. Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk[J]. Br J Sports Med, 2022, 56(13): 718-724.
[6] WANG Y, HOU R, LIU Y. Plasma homocysteine (hcy) concentration functions as a predictive biomarker of SPECT-evaluated post-ischemic hyperperfusion in acute ischemic stroke[J]. Pharmgenomics Pers Med, 2023, 16: 481-489.
[7] WU D F, YIN R X, DENG J L. Homocysteine, hyperhomocysteinemia, and H-type hypertension[J]. Eur J Prev Cardiol, 2024, 31(9): 1092-1103.
[8] LI X. Correlation between 5-HT, Hcy and the incidence and severity of autism in children[J]. Cell Mol Biol:Noisy-le-grand, 2023, 69(1): 54-60.
[9] CAVALCANTE-SILVA V, MORELHÃO P K, FERNANDES G L, et al. Homocysteine as a predictor of apnea-hypopnea index in obstructive sleep apnea: a longitudinal epidemiological study (EPISONO)[J]. Eur Arch Otorhinolaryngol, 2024, 281(6): 3237-3243.
[10] MO T, WANG Y, GAO H, et al. Sleep duration, midday napping, and serum homocysteine levels: a gene-environment interaction study[J]. Nutrients, 2023, 15(1): 210.
[11] ZITSER J, ALLEN I E, FALGÀS N, et al. Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults[J]. PLoS One, 2022, 17(6): e0270095.
[12] CHEN P, WANG W, BAN W, et al. Deciphering post-stroke sleep disorders: unveiling neurological mechanisms in the realm of brain science[J]. Brain Sci, 2024, 14(4): 307.
[13] TAYADE K, VIBHA D, SINGH R K, et al. Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study[J]. Sleep Breath, 2023, 27(6): 2429-2433.
[14] HALE E, GOTTLIEB E, USSEGLIO J, et al. Post-stroke sleep disturbance and recurrent cardiovascular and cerebrovascular events: a systematic review and meta-analysis[J]. Sleep Med, 2023, 104: 29-41.
[15] BAILLIEUL S, DENIS C, BARATEAU L, et al. The multifaceted aspects of sleep and sleep-wake disorders following stroke[J]. Rev Neurol:Paris, 2023, 179(7): 782-792.
[16] 翁汉育, 袁淑兰, 陈仰昆. 自主神经功能障碍对卒中后睡眠障碍的影响[J]. 中国实用神经疾病杂志, 2023, 26(8): 958-962.
[17] LEI W, LIU Z, SU Z, et al. Hyperhomocysteinemia potentiates megakaryocyte differentiation and thrombopoiesis via GH-PI3K-Akt axis[J]. J Hematol Oncol, 2023, 16(1): 84.
[18] PENG M, WU Y, JIN Y. Correlations of GGT, Hcy and ABI with carotid atherosclerosis in essential hypertension patients[J]. Cell Mol Biol:Noisy-le-grand, 2023, 69(15): 79-83.
[19] PRASAD K. Atherogenic effect of homocysteine, a biomarker of inflammation and its treatment[J]. Int J Angiol, 2024, 33(4): 262-270.
[20] DONG W C, GUO J L, XU L, et al. Impact of homocysteine on acute ischemic stroke severity: possible role of aminothiols redox status[J]. BMC Neurol, 2024, 24(1): 175.
[21] FAN X, LIU Y, CHEN X, et al. Synergies between diabetes and hyperhomocysteinaemia: new insights to predict and prevent adverse cardiovascular effects[J]. Diabetes Obes Metab, 2024, 26(12): 5776-5785.
[22] WANG B, MO X, WU Z, et al. Systematic review and meta-analysis of the correlation between plasma homocysteine levels and coronary heart disease[J]. J Thorac Dis, 2022, 14(3): 646-653.
[23] WU X, ZHOU Q, CHEN Q, et al. Association of homocysteine level with risk of stroke: a dose-response meta-analysis of prospective cohort studies[J]. Nutr Metab Cardiovasc Dis, 2020, 30(11): 1861-1869.
[24] LI K, ZHANG J, QIN Y, et al. Association between serum homocysteine level and obstructive sleep apnea: a meta-analysis[J]. Biomed Res Int, 2017, 2017: 7234528.
[25] CHEN T Y, WINKELMAN J W, MAO W C, et al. Short sleep duration is associated with increased serum homocysteine: insights from a national survey[J]. J Clin Sleep Med, 2019, 15(1): 139-148.
[26] QIU M H, YAO Q L, VETRIVELAN R, et al. Nigrostriatal dopamine acting on globus pallidus regulates sleep[J]. Cereb Cortex, 2016, 26(4): 1430-1439.
[27] HUANG D, KIDD J M, ZOU Y, et al. Podocyte-specific silencing of acid sphingomyelinase gene to abrogate hyperhomocysteinemia-induced NLRP3 inflammasome activation and glomerular inflammation[J]. Am J Physiol Renal Physiol, 2024, 326(6): F988-F1003.