动脉粥样硬化性心肌梗死与脑梗死患者同型半胱氨酸及危险因素的对比分析  

Homocysteine and risk factors in patients with atherosclerotic myocardial infarction and cerebral infarction: a comparative analysis

作　　者：刘君[1] 万云高[1] 赵静[1] 孙志媛[1] 杜亚芦 武剑[3] 常红[3] 

机构地区：[1]首都医科大学宣武医院心脏科,北京100053 [2]首都医科大学平谷区医院心内科,101200 [3]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国脑血管病杂志》2014年第7期354-358,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的：探讨动脉粥样硬化性急性心肌梗死（AMI）及急性脑梗死（ACI）患者与同型半胱氨酸（Hcy）的关系，以及两者危险因素的差异。方法回顾性连续纳入2010年3月-2011年10月首都医科大学宣武医院心脏科收治的初发AMI患者320例（A组）、神经内科收治的初发大动脉粥样硬化型脑梗死患者310例（B组）及无心脑血管病体检者327名（C组），3组年龄、性别相匹配。收集所有研究对象的临床资料并作对比分析。结果（1）A、B、C 3组Hcy水平[中位数（M，四分位距）]分别为15.10（12.43，19.47）、15.80（11.00，16.50）、13.20（13.10，20.83）μmol/L，3组比较差异有统计学意义（P ＜0.01）；3组高同型半胱氨酸血症（HHcy ）发生率分别为92.8％（297例）、97.1％（301例）、84.7％（277例），差异有统计学意义（P＜0.01）。（2）多因素Logistic回归分析显示，ACI的独立危险因素是HHcy（OR：8.97，95％CI：3.01～26.71）、高血压、糖尿病、高脂血症、血尿素氮；AMI的独立危险因素是HHcy（OR：4.36，95％CI：1.70～11.21）、高血压、糖尿病、高脂血症、血总胆固醇。结论 HHcy是ACI和AMI的独立危险因素，与ACI的关系更密切。ACI和AMI存在一些共同的危险因素，但其作用的程度有所不同。Objectives To investigate the relationship between atherosclerotic acute myocardial infarction （AMI）,acute cerebral infarction （ACI）and homocysteine （Hcy）. Methods Three hundred and twenty consecutive patients with primary acute myocardial infarction （AMI）（group A）were admitted to the Department of Cardiology,310 patients with primary large artery atherosclerotic cerebral infarction （group B）were admitted to the Department of Neurology,and 327 healthy individuals without cardiovascular and cerebrovascular diseases （group C）at the Department of Physical Examination,Xuanwu Hospital, Capital Medical University were enrolled retrospectively from March 2010 to October 2011. The age and sex were matched in the 3 groups. All the clinical data of subjects were colleted in detail and then were compared and analyzed. Results （1）The Hcy levels （μmol/L）of group A,B,and C were 15. 10 （12. 43, 19.47）,15. 80 （13. 10,20. 83）,and 13. 20 （11. 00,16. 50;median [interquartile range]）,respectively. There were significant differences among the 3 groups （P〈0. 05）. The incidences of hyperhomocysteinemia （HHcy）were 92. 8%（n=297）,97. 1%（n=301）,and 84. 7%（n=277）（P〈0. 05）. （2）Multivariate Logistic regression analysis showed that the independent risk factors for ACI were HHcy （OR 8. 97,95% CI 3. 01-26. 71）,hypertension,diabetes,hyperlipidemia and blood ureanitrogen;the independent risk factors for AMI were HHcy （OR 4. 36,95% CI 1. 70-11. 21）,hypertension,diabetes,hyperlipidemia,and total blood cholesterol. Conclusion HHcy is an independent factor for ACI and AMI,which have closer relationship with ACI. ACI and AMI have some common risk factors,but their degrees of action are different.

关 键 词：心血管疾病 卒中 同型半胱氨酸 动脉粥样硬化 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R542.22[医药卫生—临床医学]