同型半胱氨酸与老年急性心肌梗死及其危险因素的相关性分析  

Correlation analysis of homocysteine and acute myocardial infarction and cardiovascular risk factors in elderly patients

作　　者：张德太[1] 左曙蓉[1] 石伍和[1] 涂启明[1] 梁涛[1] 张科[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院,武汉430022

出　　处：《临床血液学杂志（输血与检验）》2014年第4期631-633,637,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:研究老年急性心肌梗死(AMI)患者血清同型半胱氨酸(Hcy)水平变化及其与AMI传统危险因素的相互作用与关系。方法:随机选择60岁以上的冠心病(CHD)患者143例,其中AMI组73例、不稳定型心绞痛(UAP)组37例、稳定型心绞痛(SAP)组33例,选择同期入院与CHD患者具有性别及年龄可比性且排除CHD诊断的患者55例作为对照组,收集临床资料并检测各组Hcy水平,综合分析。结果:血清Hcy水平AMI组较UAP、SAP及对照组,UAP较对照组均显著升高(P<0.05),其他各组间比较均无显著差异;高Hcy血症发生率AMI组显著高于对照组(P<0.05),但与UAP组及SAP组比较无显著差异;AMI组与对照组比较,性别、年龄、吸烟率、体质指数均无显著差异(均P>0.05),高血压、糖尿病、高血脂及高Hcy血症患病率则老年AMI组显著高于对照组(均P<0.05);多因素Logistic回归分析显示性别、高血压、糖尿病、高血脂及血清Hcy水平均是老年AMI的独立危险因子(P<0.05);高血压、糖尿病、高血脂及AMI的发生率高Hcy组显著高于Hcy水平正常组(均P<0.05),但吸烟率、BMI、年龄、性别则无显著差异(均P>0.05)。结论:血清Hcy是老年AMI的一项独立危险因素,Hcy水平升高与高血压、糖尿病、高血脂可能存在交互作用,促进多种危险因素的相互聚集并发生AMI。Objective：To identify the change of serum homocysteine（Hcy） levels and the relationship between high Hcy and traditional cardiovascular risk factors in elderly patients. Method： 143 elderly （over the age of 60） hospitalized patients with coronary heart disease （CHD） including 73 cases of acute myocardial infarction （AMI）, 37 cases of unstable angina pectoris（UAP）, 33 cases of stable angina pectoris （SAP） were randomly selected, meanwhile, 55 non-CHD patients with gender and age matched were randomly selected as control group. Clinical data of every patient were collected and the Hcy level was detected. Result： The Hcy level in AMI group was significantly higher than that of UAP, SAP and control group, Hcy level in UAP group was significantly higher than that of control group （P〈 0.05）, but there were no significantly difference in Hcy levels between the other groups. The rate of hyperhomocysteinaemia in AMI group was significantly higher than that of control group （P〈0.05）, but there were no significantly difference in hyperhomocysteinaemia rate among UAP, SAP and control group. The prevalence rates of hypertension, diabetes, hyperlipidemia and hyperhomocysteinemia were significantly higher in AMI group than that of control group（P（0.05）, but there were no significant differences in gender, age, smoking rate, body mass index （BMI） （P〈0.05）. Multivariate Logistic regression analysis showed gender, hypertension, diabetes, hyperlipidemia and Hcy levels were independent risk factors in elderly AMI patients（P〈0.05）. The rate of hypertension, diabetes, hyperlipidemia and the incidence of AMI in high Hcy group were significantly higher than those of normal Hcy group （all P〈0.05）, but there were no significant differences in the smoking rate, age, gender, BMI between the two groups（P〈0.05）. Conclusion：Serum H cy might be an independent risk factor of AMI in elderly patients, and elevated Hcy might interact with hypertension, diabetes and hyperl

关 键 词：急性心肌梗死 危险因素 同型半胱氨酸 

分 类 号：R542.2[医药卫生—心血管疾病]