血浆同型半胱氨酸水平对非ST段抬高急性冠脉综合征患者围术期心肌梗死及预后的影响研究  

Effect of Plasma Homocysteine Level on the Myocardial Infarction during Perioperative Period and Prognosis of Patients with Non-ST Segment Elevation Acute Coronary Syndrome

作　　者：梁海峰[1] 杨明[1] 刘瑜[2] 韩凌[1] 李晓红[1] 辛筱茗[1] 姚民 

机构地区：[1]首都医科大学附属复兴医院心内科,北京市100038 [2]首都医科大学基础医学院病理教研室,北京市100069 [3]中国医学科学院附属阜外医院冠心病中心,北京市100037

出　　处：《中国全科医学》2017年第7期823-827,共5页Chinese General Practice

基　　金：首都医科大学基础-临床科研合作基金资助课题(14JL69)

摘　　要：背景冠状动脉慢复流(CSRF)/无复流(no-RF)是经皮冠状动脉介入(PCI)治疗的重要并发症,而目前对其发病机制及临床预后研究较少。目的观察血浆同型半胱氨酸(Hcy)水平对PCI术中CSRF/no-RF现象、围术期心肌梗死(PMI)及预后的影响。方法选取2013年1月—2015年5月在首都医科大学附属复兴医院心内科及中国医学科学院附属阜外医院冠心病中心择期行PCI治疗的非ST段抬高急性冠脉综合征(NSTE-ACS)患者269例。根据血浆Hcy水平将所有患者分为Hcy正常组(<15μmol/L,n=172)和Hcy升高组(≥15μmol/L,n=97)。比较两组CSRF/no-RF、PMI发生率及PCI术后1年内主要不良心血管事件(MACE)发生率、全因死亡率。结果两组性别、年龄、吸烟率、高血压发生率、糖尿病发生率和总胆固醇(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)水平及阿司匹林、氯吡格雷/替格瑞洛、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)、他汀类药物使用率间差异无统计学意义(P>0.05),而冠状动脉病变情况间差异有统计学意义(P<0.05)。Hcy升高组CSRF/no-RF、PMI发生率均高于Hcy正常组,差异有统计学意义(P<0.05)。两组单支病变MACE发生率间差异无统计学意义(P>0.05);而Hcy升高组双支病变、多支病变及总体MACE发生率高于Hcy正常组,差异有统计学意义(P<0.05);Hcy升高组总体全因死亡率高于Hcy正常组,差异有统计学意义(P<0.05)。结论高血浆Hcy水平对NSTE-ACS患者术中CSRF/no-RF、PMI和预后有较为重要的影响。Background Coronary slow- reflow（ CSRF） /no- reflow（ no- RF） is an important complication of percutaneous coronary intervention（ PCI） therapy, but studies on its pathogenesis and clinical prognosis are not sufficient at present. Objective To observe the effects of plasma homocysteine（ Hcy） levels on CSRF / no- RF phenomena in PCI,myocardial infarction during perioperative period（ PMI） and prognosis. Methods A total of 269 patients with non- ST segment elevation acute coronary syndrome（ NSTE- ACS） undergoing elective PCI in Department of Cardiology of Fu Xing Hospital,Capital Medical University and Coronary Heart Disease Center of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2013 to May 2015 were assigned to 2 groups according to their plasma Hcy levels： normal plasma Hcy level group（ 15μmol/L,n = 172） and elevated plasma Hcy level group（ ≥15 μmol/L,n = 97）. The incidence rate of CSRF /no- RF,PMI as well as the occurrence rate of major adverse cardiac events（ MACE） and all- cause mortality 1 year after PCI between the two groups were compared in the study. Results There was no significant difference in the gender,age,smoking rate,occurrence rate of hypertension and diabetes mellitus, total cholesterol（ TC）, triglyceride（ TG）, low density lipoprotein cholesterol（ LDL-C）,high density lipoprotein cholesterol（ HDL-C） levels and usage rate of aspirin,clopidogrel /ticagrelor,β- blocker,ACEI / ARB and statins between the two groups（ P〈0. 05）,while there was significant difference in coronary artery disease lesion（ P〈0. 05）. The incidence rate of the CSRF / no- RF and PMI in the elevated plasma Hcy level group was significantly higher than that in the normal plasma Hcy level group（ P〈0. 05）. The incidence rates of single vessel disease in MACE between the two groups were not significantly different（ P〈0. 05）,but the incidence rates of double- vessel disease,multi-vessel disease and overall MACE in the elevated plasma Hcy

关 键 词：急性冠状动脉综合征 同型半胱氨酸 冠状动脉慢复流/无复流 心肌梗死 预后 

分 类 号：R541.41[医药卫生—心血管疾病]