高同型半胱氨酸血症和H型高血压对急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗预后的影响  

Effect of hyperhomocysteinemia and H-type hypertension on prognosis of patients with acute ST-segment myocardial infarction undergone primary percutaneous coronary intervention

作　　者：杨淑娟[1] 杨丽霞[1] 石燕昆[1] 王先梅[1] 陈长征[1] 郭瑞威[1] YANG Shu-juan;YANG Li-xia;SHI Yan-kun;WANG Xian-mei;CHEN Chang-zheng;GUO Rui-wei(Department of Cardiology,People＇s Liberation Army 920 Hospital,Kunming 650032,China)

机构地区：[1]解放军第九二零医院心内科(原成都军区昆明总医院),云南昆明650032

出　　处：《中国介入心脏病学杂志》2018年第11期606-612,共7页Chinese Journal of Interventional Cardiology

基　　金：云南省中青年学术和技术带头人后备人才基金(2014HB035)

摘　　要：目的回顾性分析高同型半胱氨酸血症和H型高血压对急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)预后的影响。方法回顾性分析2015年6月至2016年12月在成都军区昆明总医院心内科行直接PCI的急性ST段抬高型心肌梗死患者511例,其中226例资料完整,符合要求。按患者血清同型半胱氨酸(homocysteine,Hcy)水平是否≥15.0μmol/L及是否合并高血压分为H型高血压组68例,单纯高Hcy组54例,单纯高血压组64例及非高Hcy、非高血压组40例。比较四组患者基线资料,PCI术中及住院期间相关数据,术后1、3个月左心室射血分数,术后3个月内因再发心肌梗死、靶血管再次血运重建和再发心绞痛而再住院次数及死亡患者数。结果四组患者糖尿病、高脂血症、冠心病家族史、心绞痛史、平均首次医疗接触时间、平均入门至球囊扩张时间、心肌总缺血时间、肌酸激酶峰值、术前血糖水平、用药情况及血脂水平等比较,差异均无统计学意义(均P>0.05)。四组患者性别、平均年龄、高血压病史、吸烟比例、血清肌酸酐水平、Hcy水平、尿酸水平及术后3个月内再住院次数等比较,差异均有统计学意义(均P<0.05)。H型高血压组Hcy水平大于单纯高血压组[21.0(17.3,28.5)μmol/L比11.7(8.8,13.1)μmol/L,P<0.001],非高Hcy、非高血压组[21.0(17.3,28.5)μmol/L比10.7(8.3,11.9)μmol/L,P<0.001];单纯高Hcy组Hcy水平大于单纯高血压组[19.2(16.6,24.4)μmol/L比11.7(8.8,13.1)μmol/L,P<0.001],非高Hcy、非高血压组[19.2(16.6,24.4)μmol/L比10.7(8.3,11.9)μmol/L,P<0.001],差异均有统计学意义。H型高血压组患者3个月内再住院次数大于单纯高Hcy组[(0.80±0.51)次比(0.53±0.50)次,P=0.006],单纯高血压组[(0.80±0.51)次比(0.59±0.50)次,P=0.030]及非高Hcy、非高血压组[(0.80±0.51)次比(0.53±0.51)次,P=0.010],差异均有统计学意义。多重回归分析显示,冠心病�Objective To identify the effect of high homocysteine on prognosis in patients with acute ST-segment elevation myocardial infarction undelweut primary percutaneous coronary intervention （PPCI）. Methods From June 2015 to December 2016, 511 patients with acute ST-segment elevation myocardial infarction who had undergone PPCI in the Department of Cardiology, Kunming General Hospital of Chengdu Military Command were retrospectively reviewed. Two hundred and eighty five cases were excluded from the study owing to their incomplete follow-up data the total remaining. 226 patients were divided into four groups： H-type hypertension group （patients with hypertension and homocysteine level ≥ 15.0 μmol/L, n=68 ） ; Simple hyperhomocysteinemia group （patients with elevated homocysteine but no hypertension, n=54 ） ; Simple hypeltention group （ patients with hypertention whole homocystenine level〈15 μmol/L, n=64） , and the non-hyperhomocysteinemia, non-hypertension group （n=40） . The clinical date of all patients were collected and analyzed. Results There were significant differences in male proportion, mean age, comorbidities hypertension and smoking, creatinine concentration, Hcy concentration, average uric acid concentration, and average number of patients re-hospitalization within 3 months （P〈0.05） . Patients in the H-type hypertension group and the simple hyperteution group had higher comorbidities of hypertension than in the simple hyperhomocysteinemia group and the non-HHcy, non-hypertension group （ 100.0% vs. 0, P〈0.008 ） . There were significant differences in homocystein concentrations among the 4 groups （ all P〈0.001 ） with the highest concentration observed in the H-type hypertension group （ 21.0 μmol/L ） mean number of rehospitalizations in 3 month was highest in the H-type hypertention group as compared with the other three groups [ （ 0.80±0.51 ） times vs. （ 0.53±0.50 ） times, P=0.006; （0.80±0.51） times vs. （0.59±0.50） times, P=0.030 and （0.8

关 键 词：高同型半胱氨酸血症 H型高血压 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]