冠心病患者血浆同型半胱氨酸水平与冠状动脉病变SYNTAX积分的相关性研究

摘要

Objective To investigate the correlation between the level of plasma Hcy and the SYNTAX score of coronary artery disease of patients with coronary heart disease (CHD). Methods A total of 225 patients who were definitively diagnosed with CHD after coronary angiography (CAG)at the Department of Cardiology of General Hospital of Ningxia MedicalUniversity from July to December 2014 were selected as CHD group,and 51 patients with negative CAG were selected as the control group. According to the SYNTAX score,patients in CHD group were further divided into low - risk group (n = 74), moderate - risk group (n = 72),high - risk group (n = 79). General information 〔sex,age,BMI,systolic blood pressure (SBP),diastolic blood pressure (DBP),smoking history,history of drinking,past medical history,past medication situation, etc.〕,laboratory test results 〔fasting plasma glucose (FPG),glycosylated hemoglobin (HbA 1c ),total cholesterol (TC), triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),serum uric acid (SUA),serum creatinine (SCr),hypersensitive C - reactive protein (hs-CRP),Hcy,etc. 〕,and color Doppler ultrasound examination results of heart 〔left ventricular end diastolic diameter (LVEDD),left ventricular ejection fraction (LVEF)〕of the patients were collected. Results There was no significant difference in age,SBP and DBP among the four groups (P > 0. 05),while there was significant difference in BMI (P < 0. 05). There was no significant difference in the percentage of men,the rate of drinking and the usage rate of antidiabetic drugs,statins and antiplatelet drugs among the four groups (P > 0. 05),while smoking rate and the incidence of hypertension,diabetes and hyperlipidemia as well as the usage rate of antihypertensive drugs were significantly different (P < 0. 05). There were no significant differences in the levels of FPG,TC, SUA and hs-CRP among the four groups (P > 0. 05),while the comparison between levels of HbA 1c ,TG,LDL-C,HDL-C, SCr,Hcy and LVEDD,LVEF was significantly different (P < 0. 05). The level of Hcy was positively correlated with BMI, smoking,hypertension and levels of HbA 1c ,TC,LDL-C,SUA,SCr,hs-CRP as well as LVEDD (P < 0. 05),negatively correlated with HDL-C level and LVEF (P < 0. 05),and had no obvious correlation with other indicators (P > 0. 05). The SYNTAX score was positively correlated with hypertension and levels of SCr,Hcy as well as LVEDD (P < 0. 05),negatively correlated with levels of TG and HDL-C as well as LVEF (P < 0. 05),and had no obvious correlation with other indicators (P >0. 05). Multivariate Logistic regression analysis showed that smoking,hypertension,levels of LDL-C,HDL-C and Hcy,and LVEF were the independent factors of SYNTAX score (P < 0. 05). Conclusion Plasma Hcy level is positively correlated with SYNTAX scores among patients with CHD,and the detection of plasma Hcy level is helpful in predicting the severity of coronary artery disease in patients with CHD.%目的 探讨冠心病患者血浆同型半胱氨酸(Hcy)水平与冠状动脉病变SYNTAX积分的相关性.方法 选取2014年7—12月在宁夏医科大学总医院心内科就诊并经冠状动脉造影术(CAG)明确诊断为冠心病的患者225例为冠心病组,同时选取CAG阴性的患者51例为对照组.根据SYNTAX积分将冠心病组患者进一步分为低危组(n=74)、中危组(n=72)和高危组(n=79).收集患者的一般资料 〔包括性别、年龄、BMI、收缩压(SBP)、舒张压(DBP)、吸烟史、饮酒史、既往史、既往用药情况等〕、实验室检查结果 〔包括空腹血糖(FPG)、糖化血红蛋白(HbA 1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血尿酸(SUA)、血肌酐(SCr)、超敏C反应蛋白(hs-CRP)、Hcy等〕及心脏彩超检查结果 〔包括左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)〕.结果4组年龄、SBP、DBP间差异无统计学意义(P>0.05),而BMI间差异有统计学意义(P<0.05).4组男性比例、饮酒率及降糖药物、他汀类药物、抗血小板药物使用率间差异无统计学意义(P>0.05),而吸烟率和高血压、糖尿病、高脂血症发生率及降压药物使用率间差异有统计学意义(P<0.05).4组FPG、TC、SUA、hs-CRP水平间差异无统计学意义(P>0.05),而HbA 1c、TG、LDL-C、HDL-C、SCr、Hcy水平及LVEDD、LVEF间差异有统计学意义(P<0.05).Hcy水平与BMI、吸烟、高血压和HbA 1c、TC、LDL-C、SUA、SCr、hs-CRP水平及LVEDD呈正相关(P<0.05),与HDL-C水平及LVEF呈负相关(P<0.05);而与其他指标无明显相关(P>0.05).SYNTAX积分与高血压和SCr、Hcy水平及LVEDD呈正相关(P<0.05),与TG、HDL-C水平及LVEF呈负相关(P<0.05);而与其他指标无明显相关(P>0.05).多因素Logistic回归分析结果显示,吸烟、高血压和LDL-C、HDL-C、Hcy水平及LVEF是SYNTAX积分的独立影响因素(P<0.05).结论 冠心病患者血浆Hcy水平与S Y N T A X积分呈正相关,测定血浆H c y水平有利于预测冠心病患者的冠状动脉病变复杂程度.