The serum homocysteine level in patients with acute ischemic stroke (AIS) after thrombolysis and its relationship with clinical outcomes

Abstract

SUMMARY OBJECTIVE The present study aims to investigate whether hyperhomocysteinemia (HHcy) affects the outcomes of the thrombolytic treatment for patients with AIS. METHODS A sample of 120 AIS patients were recruited and grouped according to their serum homocysteine (Hcy) levels. The National Institute of Health Stroke Scale (NIHSS) was obtained before treatment and 7 days after it to evaluate neurological outcomes; modified Rankin Scale (mRS) was obtained 12 weeks later to assess functional outcomes. Receiver operating characteristic curve (ROC) was used to demonstrate the relationship between serum Hcy level and the outcomes after tPA treatment. RESULTS The serum Hcy level of 120 patients was of 27.57±20.17μmol/L. The NIHSS scores of the patients in the low Hcy level group were remarkably lower compared to those in the high-level group (p<0.05), after 7 days of treatment. In addition, the mRS scores of the patients in the low Hcy level group, after 12 weeks, were remarkably lower compared to those in the high-level group (p<0.01). ROC demonstrated that the serum Hcy level is related to the clinical outcomes of thrombolytic treatment with moderate specificity (80.3%) and sensitivity (58.2%). CONCLUSION In conclusion, higher serum Hcy levels can indicate poorer clinical outcomes of thrombolytic treatment in patients with AIS.

Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients

“…In addition, there was no significantly statistical difference in the incidence of sICH between Hhcy group and non-Hhcy group in the present study. However, previous studies found that patients with Hhcy tended to have a higher incidence of sICH (10, 11). Thus, the association between Hhcy and sICH needs further investigation in the future.…”

“…However, in a retrospective study of 194 patients with ischemic stroke, Yao and colleagues found that compared with the first quartile (2.26–11.50 μmol/L) of serum homocysteine levels, the fourth quartile (23.85–138.90 μmol/L) had the highest risk of poor outcome after thrombolysis (OR = 13.65; 95% CI: 3.58–51.97) (10). Another retrospective study included 120 ischemic stroke patients and also found that compared with the first quartile (2.26–11.50 μmol/L) of serum homocysteine levels, the fourth quartile (23.85–138.90 μmol/L) was independently associated with an increased risk of poor outcome after thrombolysis (OR = 13.75; 95% CI: 3.57–51.77) (11). These inconsistent results might be caused by small sample sizes.…”

“…However, the role of Hhcy in the clinical outcome of ischemic stroke remains controversial. Some studies found that Hhcy was associated with increased risk of poor outcome in ischemic stroke patients (6–11), whereas some studies showed no significant association between Hhcy and the clinical outcome of ischemic stroke (12–16). In addition, previous studies have found that Hhcy was implicated in the disruption of the blood-brain barrier, and the breakdown of the blood-brain barrier played a critical role in the development of HT in ischemic stroke patients with thrombolysis (17, 18).…”

Retinal ischemia as the first manifestation of antiphospholipid antibody syndrome

“…Homocysteine (Hcy) is a sulfur amino acid derived from methionine metabolism and its slightly increased concentration is a risk factor for the development of vascular diseases, as it can lead to endothelial dysfunction and increased prothrombotic factors. (3,4) Hyperhomocysteinemia may be caused by a deficiency of folic acid, vitamin B12 and B6 because they are important elements in Hcy metabolism. (3) However, the patient did not have theses nutritional deficiencies, which indicates that the elevation of this amino acid may have been due to drug interactions.…”

The design of a homocysteine fluorescent probe based on Rhodamine B and its responsiveness in the serum of cerebral infarction patients�

“…Hcy is a sulfur-containing amino acid that cannot be synthesized in vivo and can only be produced by the catabolism of methionine (10). Under normal circumstances, the Hcy content in the blood is very low, and high concentrations of Hcy have been found to be an independent risk factor for coronary artery disease, cerebrovascular disease and peripheral vascular disease; the risk of developing these conditions are increased with the increase in Hcy concentration (11)(12)(13)(14).…”