高HCY血症对ACS患者LPA、炎症因子、血小板参数及DAPT治疗的影响  

Effect of hyperhomocysteinemia on LPA,inflammatory factors,platelet parameters and DAPT treatment in patients with ACS

作　　者：李瑞瑞 刘恩香 李晶晶 何洪月 LI Rui-rui;LIU En-xiang;LI Jing-jing;HE Hong-yue(Department of Cardiology,Cangzhou People′s Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市人民医院心内一科,河北沧州061000

出　　处：《热带医学杂志》2020年第9期1206-1209,1235,共5页Journal of Tropical Medicine

基　　金：沧州市重点研发计划指导项目(172302128)。

摘　　要：目的探究高同型半胱氨酸(HCY)血症对急性冠脉综合征(ACS)患者溶血磷脂酸(LPA)水平及对双联抗血小板药物治疗(DAPT)的影响。方法选取沧州市人民医院2012年8月-2017年8月收治的110例ACS患者,根据HCY水平(是否≥15μmol/L)分为高HCY组(n=47)和非高HCY组(n=63),所有患者均行DAPT干预,对比两组患者治疗前后临床各指标差异情况,分析HCY与临床其他指标的相关性,并比较两组治疗后12~24个月缺血事件和出血事件的发生率。结果治疗前,两组患者年龄、性别、体质量指数、ACS家族史、是否合并高血压、PRECISEDAPT评分、左心室射血分数(LVEF)、血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]比较差异无统计学意义(P>0.05),两组HCY、LPA、炎性因子[白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]、血管内皮生长因子(VEGF)、血小板参数[血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板计数(PLT)、血小板聚集率(PAR)]比较差异具有统计学意义(P<0.05)。治疗后,两组PRECISE-DAPT评分、HCY、LPA、LVEF、TC、TG、HDL-C、LDL-C、IL-6、hs-CRP、TNF-α、VEGF、MPV、PDW、PLT及PAR比较差异均有统计学意义(P<0.05)。相关性分析结果显示,HCY与PRECISE-DAPT评分、LPA、TC、TG、LDL-C、IL-6、hs-CRP、TNF-α、MPV、PDW、PAR存在显著正相关性(P<0.05),与HDL-C、VEGF、PLT存在显著负相关性(P<0.05)。高HCY组的缺血事件(心肌梗死、心源性死亡、卒中)(17.0%vs. 4.8%)和出血事件(10.6%vs. 1.6%)发生率明显高于对照组,差异有统计学意义(x2=4.495、4.276,P均<0.05)。结论高HCY血症导致ACS患者机体LPA、炎症水平升高,血小板聚集和血管内皮功能损伤等,从而降低DAPT的治疗效果,增加患者预后不良事件的发生。Objective To investigate the effects of hyperhomocysteinemia on the level of lysophosphatidic acid(LPA) in patients with acute coronary syndrome(ACS) and the effect of dual antiplatelet therapy(DAPT).Methods A total of 110 patients with AC.S treated in our hospital from August 2012 to August 2017 were selected and divided into high homocysteine(HCY) group(n=47) and non-high HCY group(n=63) according to HCY level(whether ≥15 μol/L).All patients were treated with DAPT.The clinical indicators were compared between the two groups before and after treatment.The correlation between HCY and other clinical indicators was analyzed,and the incidence of ischemic events and bleeding events rates between 12 and 24 months after treatment were compared.Results Before treatment,the age,sex,body mass index,family history of ACS,whether combined with hypertension,PRECISE-DAPT score,left ventricular ejection fraction(LVEF),lipid index [total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and lowdensity lipoprotein cholesterol(LDL-C)] were not statistically significant(P>0.05).HCY,LPA,and inflammatory factors[interleukin-6(IL-6),high-sensitivity reaction protein(hs-CRP),tumor necrosis factor-α(TNF-α)],vascular endothelial growth factor(VEGF),platelet parameters [mean platelet volume(MPV),platelet distribution width(PDW),platelet count(PLT),and platelet aggregation rate(PAR)] were statistically significant(P<0.05).After treatment,the PRECISE-DAPT score,HCY,LPA,LVEF,TC,TG,HDL-C,LDL-C,IL-6,hs-CRP,TNF-α,VEGF,MPV,PDW and PLT of the two groups were significantly different(P<0.05).Correlation analysis results showed that HCY and PRECISEDAPT score,LPA,TC,TG,LDL-C,IL-6,hs-CRP,TNF-α,MPV,PDW,PAR showed significant positive correlation,and significant negative correlation with HDL-C,VEGF,and PLT(P<0.05).The differences in the incidence of ischemic events(myocardial infarction,cardiogenic death,stroke) and bleeding events between the two groups were statistically significant(P<0.05).Conclusion Hyperhomocyste

关 键 词：急性冠脉综合征 高同型半胱氨酸血症 溶血磷脂酸 双联抗血小板药物治疗 

分 类 号：R541.4[医药卫生—心血管疾病]