- 學位論文
使用血漿同半胱胺酸濃度預測社區舒張功能不全成年之總死亡風險-13年追蹤研究
Use of plasma homocysteine concentration to predict the risk of all-cause death in adults with diastolic dysfunction in a community – A 13-year follow-up study
摘要
背景：血液中的同半胱胺酸濃度上升己經被證實和心血管疾病有很大的關聯性存在。而在心衰竭的病人上面，也可以發現不只和發生率有很大的關係之外，也可以有效的預測預後。我們設計了一個世代研究，想要探討在舒張功能不全的成年上面，同半胱胺酸的濃度上升是否是預後不良的一個危險因子。 研究方法：金山社區心血管研究計畫The Chin-Shan Community Cardiovascular Cohort (CCCC) 最初就是為了測量心血管疾病的預後及趨勢所設計的。在金山地區，年齡大於35歲則會被收入到研究內。我們將病人依照血漿中同半胱胺酸濃度的高低平均分成四組。我們有Cox proportional hazards models的方法，去計算同半胱胺酸濃度最高的那組比上濃度最低的組之危險比。我們也畫出了Receiver operating characteristic (ROC) 曲線，並且計算了曲線下的面積。另外我們也對相關的危險因子做分層分析，想要去查看是否有修飾因子的存在。 研究結果：從1990年開始，我們總共收入了3602個成年居民。最後在1994年到1995年間共有2020位居民完成心臟超音波的檢查。在這13年間，總共有75位成年死亡。在效正了許多危險因子之後，高同半胱胺酸血症(hyperhomocysteinemia)仍然和不良的預後有著明顯的關聯性存在(危險比1.07, 95%信頼區間1.01-1.14。在同半胱胺酸濃度最高的那一組的受試者有比濃度最低那組的受試者，有1.90倍的總死亡風險。而當我們使用11.11μmol/L做切點將受試族群分成兩組之後，同半胱胺酸高於11.11μmol/L的那組其總死亡風險增加0.88倍，95%信頼區間為1.07-3.29。同半胱胺酸的確是心血管疾病的危險因子，且在效正過各項因子後，仍和不良預後有著明顯的關聯性存在。 結論：本研究發現社區舒張功能不全成年中，其血漿中同半胱胺酸濃度和不良預後有著顯著的相關性存在。而在老年族群中，同半胱胺酸濃度的上升對不良預後有更好的預測能力。
並列摘要
Background：Hypermohocysteinemia was found highly associated with systolic heart failure and it could also predict progosis. We conducted a cohort study to find whether hyperhomocysteinemia was associated with poor prognosis in diastolic dysfunction patients. Method：The Chin-Shan Community Cardiovascular Cohort (CCCC) study was designated to measure the trends of cardiovascular morbidity and mortality in a community. Individuals who were aged 35 and above were enrolled. Participants were classified by quartiles of homocysteine concentration. We used multivariate Cox proportional hazards models to calculate the hazard ratio of the fourth quartiles versus the first quartile. Receiver operating characteristic (ROC) curve was constructed, and area under curve was calculated. We also performed stratification to find the effect modifier. Results：A total of 3602 participants were enrolled, and 2020 participants completed echocardiography. Among the 2020 participants, 231 individual had diastolic dysfunction. Total 75 participants died during follow-up period. After adjusted with multiple variants, hyperhomocysteinemia was significantly associated with poor prognosis with a hazard ratio of 1.07(1.01-1.14). Participants in the highest quartile had a 1.90 ( 95% CI, 0.88-4.12, p for trend, 0.026) fold risk for all cause death compared with those in the lowest quartiles. The hazard ratio was 1.88(95% CI, 1.07-3.29) using 11.11μmol/L as cutpoint. Conclusion：Hyperhomocysteinemia was significantly associated with poor prognosis in diastolic dysfunction participants. Homocysteine was a good predictor for all-cause death among old age adults.
參考文獻
延伸閱讀
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