轻中度高同型半胱氨酸血症与冠心病的关系探讨  

Correlation between mild and moderate hyperhomocysteinem and coronary heart disease

作　　者：陈顺华[1] 张冬花[2] 郭芳[1] 冯妍[1] 王以新[1] 

机构地区：[1]首都医科大学附属北京安贞医院全科医疗科,100029 [2]首都医科大学附属北京安贞医院心内科十五病房,100029

出　　处：《中国医药》2013年第6期733-735,共3页China Medicine

摘　　要：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Hey、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Hey、hs—CRP及Fib的差异；采用Logistic回归模型进行分析，确定Hey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、高胆周醇血症病史、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[Hey：（21±6）Ixmol／L比（16±5）、（14±5）Ixmol／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Hey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〉15μmol/L定义高Hcy血症，ACS组高Hey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Hey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（a）1．045—1．13l，P〈0．011和2．582（OR=2．582，95％C11．643—4．056，P〈0．01）。结论Hey是冠心病的独立危险因素�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 high- sensitivity C-reactive protein （hs-CRP） were detected. The traditional risk factors and plasma/-Icy, 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 HI）L-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. l）mg/L vs（2.8 ± 1.9）, （2.1 ± 1.9）mg/L; Fib： （4.1 ±.9）g/L vs（2.6 ±.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 hyper- homocysteinem（ Hcy 〉 15 μmol/L） were more in ACS group t

关 键 词：冠心病 同型半胱氨酸 急性冠状动脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]