目的 研究血浆同型半胱氨酸(Hcy)与冠心病之间的相关性,初步探讨Hcy导致冠心病的机制.方法 2012年9月1日至12月30日356例冠心病患者中急性冠状动脉综合征(ACS)组279例,稳定型心绞痛(SAP)组77例,同期冠状动脉造影阴性者159例作为对照组.记录入选对象的性别、年龄、吸烟史、高血压病史、糖尿病史、高胆固醇血症病史、脑血管病史、BMI、TC、LDL-C、HDL-C水平、血浆Hcy、纤维蛋白原(Fib)及高敏C反应蛋白(hs-CRP)水平,组间比较传统心血管病危险因素的差异及血浆Hcy、hs-CRP及Fib的差异；采用Logistic回归模型进行分析,确定Hcy是否是冠心病的独立危险因素.结果 3组在年龄、高血压病史、高胆固醇血症病史、TC、LDL-C方面差异无统计学意义(P＞0.05),但3组在性别、吸烟史、糖尿病史、脑血管病史、HDL-C方面差异有统计学意义(P＜0.05)；ACS组血浆Hcy、hs-CRP及Fib水平高于SAP组及对照组[Hcy:(21±6)μmol/L比(16 ±5)、(14±5)μmol/L; hs-CRP:(4.5 ±2.1)mg/L比(2.8±1.9)、(2.1±1.9) mg/L;Fib:(4.1±0.9) g/L比(2.6±0.7)、(2.7±0.8)g/L],差异均有统计学意义(均P＜0.05)；SAP组与对照组比较,血浆Hcy水平差异有统计学意义(P＜0.05),hs-CRP及Fib水平差异无统计学意义(P＞0.05)；以＞ 15 μmol/L定义高Hcy血症,ACS组高Hcy血症患者多于对照组及SAP组,差异有统计学意义(P＜0.05),而SAP组及对照组比较则差异无统计学意义(P＞0.05)；多元Logistic回归分析显示,无论血浆Hcy水平或高Hcy血症作为自变量,均为冠心病的独立危险因素,相对危险度分别为1.087[比值比(OR)=1.087,95％置信区间(CI) 1.045～1.131,P＜0.01]和2.582(OR=2.582,95％ CIl.643 ～4.056,P＜0.01).结论 Hcy是冠心病的独立危险因素,ACS患者血浆Hcy水平高于SAP患者,提示Hcy可能通过参与炎症与血栓机制导致冠心病的发生发展.%Objective To study the correlation between plasma homocysteine(Hcy) and coronary heart disease(CHD),and to discuss the mechanism of Hcy inducing CHD,so that providing data for clinic job.Methods All 356 CHD patients were investigated.Among the patients,there were 279 with acute coronary syndrome (ACS group) and 77 with stable angina pectoris (SAP group).At the same time 159 normal persons were selected as control group (NC group).Sex,age,body mass index(BMI),history of smoking,hypertension,diabetes,hypercholesterolemia,cerebrovascular disease,the levels of total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),plasma Hcy,plasma fibrinogen(Fib) and highsensitivity C-reactive protein (hs-CRP) were detected.The traditional risk factors and plasma Hcy,Fib,hs-CRP were compared between groups.The multiple risk factors of CHD were analyzed by using Logistic regression model for determining whether Hcy was an independent risk factor of CHD.Results There were no statistically differences among three groups in terms of age,history of hypertension and hypercholesterolemia,the level of TC,LDL-C (P ＞0.05).There were statistically difference in three groups on sex,history of smoking,diabetes,cerebrovascular disease and the level of HDL-C(P ＜0.05).The levels of plasma Hcy,hs-CRP,Fib in ACS group were statistically higher than those in SAP group and NC group [Hcy:(21 ± 6) μmol/L vs (16 ± 5),(14 ± 5) μmol/L; hs-CRP:(4.5 ±2.1)mg/L vs(2.8 ± 1.9),(2.1 ± 1.9)mg/L; Fib:(4.1 ±0.9)g/L vs(2.6 ±0.7),(2.7 ±0.8) g/L](P ＜ 0.05) ;The levels of plasma Hcy were statistically higer in SAP group than that in NC group (P ＜ 0.05),but the levels of hs-CRP and Fib were no difference between SAP group and NC group(P ＞ 0.05).Patients with hyperhomocysteinem(Hcy ＞ 15 μmol/L)were more in ACS group than those in NC and SAP group(P ＜ 0.05),but there was no difference between NC and SAP group(P ＞0.05).The multiple analysis of Logistic regression showed that whether the level of plasma Hcy or hyperhomocysteinem were an independent risk factor of CHD; the relative risk was 1.087 [odds ratio (OR) =1.087,95％ confidence interval(CI) 1.045-1.131,P ＜ 0.01) and 2.582 (OR =2.582,95％ CI 1.643-4.056,P ＜ 0.01).Conclusions The Hcy is an independent risk factor of CHD.The level of plasma Hcy is higher in ACS patients than that in SAP patients,which indicates that Hcy may increase the risk of CHD through inducing inflammation and thromb.
展开▼
