| ObjectiveObjective to study the relationship between serum homocysteine level and stroke in atrial fibrillation,and further explore serum homocysteine levels of traditional Chinese medicine and the correlation of atrial fibrillation in patients with stroke score,and explore its possible mechanism.MethodsRetrieved Pubmed and Google schalor,the Cochrane library,clinicaltrial database and Chinese Hownet,VIP,Wanfang database,collected about atrial fibrillation and serum homocysteine levels of cohort and case-control studies.The quality of literature was evaluated using the NOS scale and Revman 5.3 software for Meta analysis.We further reviewed and analyzed 126 patients who were hospitalized in Department of Cardiology and Cardiac Arrhythmia,Guangdong Provincial Hospital of Traditional Chinese Medicine between January 1,2016 and December 31,2017.These included basic information of patients,the TCM four diagnostic information and test and inspection results.Grouping according to CHA2DS2-VASc score and stroke risk of atrial fibrillation,and using SPSS 17.0 statistical software to analyze the data of each group.According to the nature of data,t test,ANOVA,chi square test and rank sum test were used.Correlation analysis was performed using Pearson and Spearman correlation analysis.Correlation coefficient was more than 0 positive correlation,and negative correlation was less than 0.The difference was statistically significant in P<0.05.Results(1)Five literatures were included with the serum Hey level as the outcome index,which included in the total number of 522 cases,188 cases of atrial fibrillation with stroke,334 cases of atrial fibrillation,examined the heterogeneity and chi-square=5.38,the degrees of freedom is 4,??0.025,I2?26%.The fixed effect model was used for the analysis.The 95%CI of the combined effect of MD was 3.93[3.37-4.49],the combined effect ofthe test Z=13.70,P<0.00001,suggesting that the difference of serum Hcy level between patients with atrial fibrillation and apoplexy was statistically significant.(2)Clinical data comparison:according to the risk group of atrial fibrillation stroke,compared with age of high-risk,the mid-risk group(73.68±8.81 vs 64.18±7.38,P<0.01)and the low-risk group(73.68±8.81 vs 55.84±7.08,P<0.01)were statistically significant.The use of medication,for ARB,low-risk group less than the mid-risk group(0 vs 35.3%,P<0.01)and high-risk group(0 vs 52.2%,P<0.01),for hypoglycemic drugs,the high-risk group was more than low-risk group(35.6%vs 0%,P<0.01)and mid-risk group(35.6%vs 0%,P<0.01),the difference was statistically significant.There was no significant difference in other data.(3)Test and inspection comparison:The HCY level of the high-risk group was higher than mid-risk group(13.65 vs 11.00,P<0.05)and the low-risk group(13.65 vs 9.40,P<0.001),the difference was statistical significance.The mean size of the left atrium in the high-risk group was greater than that in the low-risk group(42.38±8.31 vs 34.42±7.18,P<0.001),and the difference was statistically significant.(4)Symptomatic distribution:The most common syndromes were qi deficiency(52.38%,66/126),followed by phlegm(48.41%,61/126),again for blood stasis(31.74%,40/126)and yin deficiency(28.57%,36/126).The highest proportion of patients in low-risk group was sputum(68.4%),qi deficiency(52.6%),blood stasis(36.8%)and water-rheum(31.6%).The highest proportion of mid-risk group was qi deficiency(52.9%),yin deficiency(52.9%)and sputum(29.4%).The highest proportion of high-risk groups was qi deficiency(52.2%),sputum(47.8%)and blood stasis(34.4%).(5)Spearman correlation analysis of HCY level with CHA2DS2-VASc score and risk of atrial fibrillation stroke:The level of serum homocysteine was positively correlated with CHA2DS2-VASc score and the risk of atrial fibrillation stroke,and the correlation was statistically significant(the correlation coefficient r=0.428,0.447,P<0.001).(6)The relationship between HCY level and stroke risk factors in atrial fibrillation:The level of HCY in patients with atrial fibrillation and congestive heart failure,hypertension,diabetes,stroke and vascular disease is higher than that in non merger group,the difference was statistically significant(Z=-2.481?-3.047?-2.865?2.113?-2.566,P<0.05).(7)Correlation analysis of HCY level and left atrial diameter:Drawing HCY level and left atrium diameter scatter plot,which suggested that there was no linear correlation between the left atrium diameter and the level of HCY(R2=0.068).(8)Correlation test between TCM syndrome and CHA2DS2-VASc score:There was no correlation between TCM syndromes and CHA2DS2-VASc scores(X2?5.75,P>0.05).Conclusion(1)Serum homocysteine levels were significantly elevated in patients with nonvalvular atrial fibrillation with ischemic stroke,and there was a positive correlation between serum homocysteine levels and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation,which indicated that the detection of serum homocysteine levels may become auxiliary predictor of stroke in atrial fibrillation.(2)Clinically,the serum homocysteine level in patients with nonvalvular atrial fibrillation is affected by many diseases,and has nothing to do with the size of the left atrial diameter,and its specific mechanism between atrial fibrillation and still need further discussion.(3)There is no significant correlation between the distribution of TCM syndrome and CHA2DS2-VASc score in patients with atrial fibrillation,which could not be used as a predictor of stroke risk in patients with atrial fibrillation. |
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