血浆同型半胱氨酸浓度对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后左心室重构的影响  

Influence of plasma concentration of homocysteine on left ventricular remodeling in patients with STsegment elevation acute myocardial infarction after percutaneous coronary intervention

作　　者：孙亚武[1] 杨向军[1] 张俊杰[1] 陆曙[1] 

机构地区：[1]太仓市第一人民医院,苏州太仓215400

出　　处：《岭南心血管病杂志》2015年第5期606-609,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的通过比较不同血浆同型半胱氨酸（homocysteine,Hcy）浓度的急性ST段抬高型心肌梗死（STsegment elevation acute myocardial infarction,STEMI）患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后1个月、6个月、12个月的左心室舒张末期直径（left ventricular end-diastolic diameter,LVDd）和左心室射血分数（left ventricular ejection fraction,LVEF）,探讨血浆Hcy浓度对PCI治疗后左心室重构的影响。方法 110例STEMI患者入院第二天清晨空腹（禁食10 h以上）抽取静脉血检测血浆Hcy浓度,并根据血浆Hcy浓度分为Hcy正常组、Hcy轻度升高组（15~30μmol/L）、Hcy中-重度升高组（〉30μmol/L）。用超声心动图随访3组患者PCI治疗后1个月、6个月、12个月的LVDd、LVEF并进行比较。结果 PCI治疗后1个月3组左心室重构指标比较,差异无统计学意义（P〉0.05）。中-重度升高组PCI治疗后6个月左心室重构指标与Hcy正常组、Hcy轻度升高组比较,差异有统计学意义（P〈0.05）;Hcy正常组、Hcy轻度升高组之间比较,差异无统计学意义（P〉0.05）;3组左心室重构指标PCI治疗后12个月两两比较,差异有统计学意义（P〈0.05）。结论血浆Hcy浓度可以影响STEMI患者PCI治疗后心室重构,特别是血浆Hcy浓度中-重度升高STEMI患者早期即出现严重的心室重构。Objectives To explore the impact of plasma concentration of homocysteine（Hcy） on left ventricular remodeling by comparing the differences in left ventricular end-diastolic diameter（LVDd） and left ventricular ejection fraction（LVEF）in ST- segment elevation acute myocardial infarction（ STEMI） patients with different plasma concentrations of Hcy1 month, 6 months and 12 months after percutaneous coronary intervention（PCI）. Methods Plasma concentrations of Hcy in 110 patients with STEMI were detected on the next day morning after admission（fasted for 10 h or more） and they were divided into 3 groups according to the plasma concentrations of Hcy ： normal Hcy group, slightly elevated Hcy group（15-30 μmol / L）, moderately-to-severely elevated Hcy group（〉30 μmol / L）. LVDd and LVEF were detected and compared among the three groups by echocardiography 1 month, 6 months and 12 months after PCI.Results Differences in left ventricular remodeling indexes among the three groups 1 month after PCI were not statistically significant（P〉0.05）. Left ventricular remodeling indexes 6 months after PCI in moderately-to-severely elevated Hcy group had statistically significant differences compared with those in normal Hcy group and slightly elevated Hcy group（P〈0.05）, but the difference between normal Hcy group and slightly elevated Hcy group was not statistically significant（P〈0.05）. Differences in left ventricular remodeling indexes 12 months after PCI among the three groups were statistically significant（P〈0.05）. Conclusions Hcy can affect ventricular remodeling in patients with STEMI after PCI, especially severe ventricular remodeling can occur earlier in patients with moderately-to-severely elevated plasma concentrations of Hcy.

关 键 词：心肌梗死 同型半胱氨酸 心室重构 

分 类 号：R542.22[医药卫生—心血管疾病]