Synergistic effect between Smoking and hyperhomocystinemia on incidence of coronary heart disease / 实用医学杂志

Objective To investigate the synergistic effect of hyperhomocystinemia (HHcy) and smoking on the incidence of Coronary heart disease. Methods A total of 22 043 subjects were enrolled from health care center. Participants were classified into two groups: Non-coronary heart disease group (control group, n = 19 410) and coronary heart disease group(n=2 633).A questionnaire survey,physical examination and blood homocysteine (Hcy)test were carried out among the participants.Results After controlling the confounding factors,multivariable Logistic regression analysis showed that the risk of coronary heart disease in patients with smoking was 4.832 times higher than that of patients with normal waistline. The risk of coronary heart disease in patients with HHcy was 1.019 times higher than that of patients with normal Hcy (OR = 4.832,1.019,P < 0.05).Interaction analysis showed that the risk of patients with HHcy and smoking was 2.473 times higher than that of patients without HHcy and no-smoking.The synergy index between HHcy and smoking on the incidence of Coronary heart disease was 1.739. The pure attributable proportion due to the interaction was 42.9%. Conclusions HHcy and smoking are risk factors for coronary heart disease and there is a positive synergistic effect between HHcy and smoking on the incidence of coronary heart disease.

Analysis on the correlation between hyperhomocystinemia and the incidence of senile dementia / 国际检验医学杂志

Objective To analyze the relationship between hyperhomocystinemia (HHcy) and occurrence of Alzheimer disease (AD) .Methods A total of 100 cases of elderly patients with dementia were collected ,from April 2010 to May 2013 ,and divided in‐to AD group and vascular dementia (VD) group according to patients′condition .Other 50 cases of healthy elderly individuals were collected in the control group .Levels of homocysteine (Hcy) were detected ,and the relationship between level of Hcy and occur‐rence of AD was analysed .Results Levels of Hcy in the AD group and VD group were higher than that in the control group ,and were decreased after treatment ,there were statistically significant differences(P<0 .05) .After treatment ,the scores of mini‐mental state examination(MMSE) in the AD group and VD group both were increased ,and the score of activity of daily living scale(ADL) was decreased in the AD group ,there were statistically significant differences (P<0 .05) .The level of Hcy in mild AD patients was lower than that in severe AD patients ,the difference was statistically significant (P<0 .05) .The AD odds ratio(OR) was 4 .7 ,and 95% confidence interval(CI) was 1 .76 -7 .09 .The level of Hcy in patients with AD was significantly negatively correlated with score of MMSE ,the coefficient value(r) was -0 .32 ,-0 .40 and -0 .27 in mild ,moderate and severe AD(P<0 .05) .Conclusion HHcy is an independent risk factor for the onset of AD ,so attention should be paid on high Hcy level ,in order to prevent AD .

Analysis of risk factors for cerebral microbleeds in patients with acute ischemic stroke of large-artery ath-erosclerosis / 中国神经精神疾病杂志

Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.

The Levels of Hyperhomocystinemia and the Types of Ischemic Cerebrovascular Disease / 国际脑血管病杂志

Objective:To explore the relationship betwwen the different types of ischemic cerebrovascular disease andthe levels of plasma Homocystine(Hcy).Methods:The levels of plasma Hcy in 135 patients with ischemic cerebrovascular disease were measured by the fluorometric method.All the patients were divided into transient ischemic attack(TLA)group and atherothrombotic cerebral infarction(ACO group.The patients in both groups and the levels of plasma Hcy between the primary ACI and recurrent ACI were compared.Results:The levels of plasma Hcy in the ACI group(22.0±6.4 μmol/L)group were significantly higher than those in the TIA group(16.6±6.0 μmol/L)(P＜0.01),and the levels of plasma Hcy in the recurrent ACI group(23.0±5.5 5 μmol/L)were significantly higher than those in the primary group(19.6±5.9 μmol/L)(P＜0.01).There were rio significant differences between the two groups in age,sex,history of smoking.lipid,body mass index,as well as the prevalences of hypertension,diabetes mellitus and coronary heart disease.Conclusions:The increased level of plasma Hcy is closely associated with ACI.and it is a risk factor for recurrent stroke.

The role of hyperhomocystinemia in the oxidative stress and inflammation injury mechanism of ischemic injury in cerebral infarction / 中华神经科杂志

Objective To explore the mechanism of cerebral infarction caused by hyperhomocystinemia.Methods A hundred and nineteen paitents with acute cerebral infarction were chosen for case group.According to their levels of plasm total homocystine,they were divided into two groups: hyperhomocystinemia group and nonhyperhomocystinemia group.Forty patents without cerebrovascular disease,hepatophy,nephrosis and thyroid gland disease were chosen as control subjects.Plasm levels of total homocystine,serum levels of MDA and IL-8 were measured respectively,their correlations were also studied.Results Plasma levels of tHcy(?mol/L)and serum levels of MDA(nmol/L)and IL-8 (ng/ml)showed a significant increase in case group(19.97,4.41?0.84,0.23?0.08)in comparison with control subjects(9.83,3.24?0.64,0.12?0.08),t values were 8.139,8.021,7.767 respectively(P

inical and radiological features of the late-onset methylmalonic aciduria: a review of three cases / 中华神经科杂志

jective To study the clinical and radiological features of the patients with late-onset methylmalonic aciduria ( MMA). Methods Two men and one woman with MMA were screened and confirmed by urinary organic acid analysis with gas chromatograph/mass spectrometer (GC/MS) at their 26, 18 and 34 years old, respectively. Their clinical features, laboratory findings, radiological manifestations, treatment and outcome were reviewed. Results The clinical features of 3 patients were varied with neurological abnormalities. Case 1 had periodic enuresis for 16 months, progressive dementia and movement disorder for 3 months. Physical examination showed an apparent cognitive decline with psychiatric symptoms. Dysarthria, bilateral weakness and pyramidal signs, rigidity and mild tremor of limbs were observed. Case 2 had a progressive memory deterioration, learning difficulty, walking unstably and decreased vision when he was 13 years old, and a general seizure at an age of 16 years. Diffused abnormalities of EEG and rnild renal defects were found in the above two patients. General white matter hyperintensity and cerebral atrophy on T2-weighted MR images were evident. Additionally, these two patients had hyperhomocystinemia and carnitine deficiency. Case 3 had complained about walking unstably and fatigue over 2 months. Reduced facial movements, deep sensation loss and muscle weakness in lower extremities, marked rigidity and diminished tendon reflexes were detected. Megaloblastic anemia and cobalamin deficiency were found. MRJ performed revealed bilateral symmetric areas having high density involving the globi pallidi, posterior limbs of internal capsule and the cerebral peduncles. Remarkable elevations of urinary methylmalonic and methylcitric acid were confirmed in all 3 patients. After vitamin B12 supplementation, significant improvement was observed. Conclusion Three cases with vitamin BI2 responsive type of late-onset MMA were reported. Two patients were combined with hyperhomocystinemia and the other had only isolated MMA. There might remain prominent differences among MMA subgroups in clinical presentations and neuroradiologic findings. VitaminB12 might be very effective to improve the prognosis of the patients. MMA should be considered as a differential diagnosis for the etiological investigation of adult cerebral metabolic or degenerative diseases.