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颈动脉夹层高同型半胱氨酸血症和亚甲基四氢叶

Background: Cervical artery dissection (CAD) is a recognized cause of ischemic stroke. Hyperhomocysteinemia (HHcy), i.e. an elevated concentration of plasma homocysteine, is iden- tified as an independent risk factor for stroke prevalence. However, an association between HHcy and CAD has so far remained unknown. 

Methods: A meta-analysis was per- formed to analyze the association between HHcy and CAD as well as the relevance of the C677T polymorphism of meth- ylenetetrahydrofolate reductase (MTHFR), the key enzyme in homocysteine metabolism during CAD. We searched PubMed and Embase for studies reporting homocysteine concentrations or MTHFR genotype frequencies in CAD pa- tients from 1990 to 2013. Outcomes were extracted from studies meeting the inclusion criteria and were subjected to a meta-analysis by the random-effect model. Heterogeneity was assessed by the Itest. 

Results: Eight case-control stud-ies with 2,146 individuals fulfilled the required criteria and were included in the meta-analysis. HHcy was found to be significantly associated with CAD (pooled standardized mean difference: 0.96; 95% confidence interval, CI: 0.42– 1.49; p < 0.01). We also found a significantly increased risk of CAD in individuals with the MTHFR C677T polymorphism by both the recessive model (TT vs. CT+CC; odds ratio, OR = 1.81; 95% CI: 1.22–2.67; p = 0.003) and the dominant model (TT+CT vs. CC; OR = 1.47; 95% CI: 1.08–1.99; p = 0.014). Con- clusion: Our data suggest positive correlations between HHcy and CAD and between the C677T polymorphism of MTHFR and CAD