冠状动脉病变与同型半胱氨酸的关系研究  

Correlation between the severity of coronary artery stenosis and homocysteine

作　　者：熊日新[1] 刘伶[1] 袁军[1] 王孟杰[1] 黄宗燕[1] 杨子聪[1] 曾涛[1] 林英忠[1] Xiong Rixin;Liu Lin;Yuan Jun;Wang Mengjie;Huang Zongyan;Yang Zicong;Zeng Tao;Lin Yingzhong(Department of Cardiology,The People's Hospital of Guangxi Zhuang Autonomous Region,Guangxi Coronary Heart Disease Clinical Research Center,Guangxi Institute of Coronary Heart Disease,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院心血管内科,广西冠心病临床研究中心,广西冠心病研究所,南宁530021

出　　处：《中国心血管杂志》2020年第6期530-534,共5页Chinese Journal of Cardiovascular Medicine

基　　金：广西医药卫生自筹经费计划课题项目(Z2015310);广西科技基地和人才专项(桂科AD17129026)。

摘　　要：目的分析年龄≤45岁冠心病患者冠状动脉Gensini积分与血浆同型半胱氨酸(HCY)的相关性。方法回顾性纳入2014年1月1日至2018年6月30日在广西壮族自治区人民医院住院行冠状动脉造影检查且年龄≤45岁患者,分析其临床特征,运用Gensini积分方法计算冠状动脉病变程度,根据Gensini积分的四分位数间距进行如下分组:G1组(Gensini积分≤14分,40例),G2组(14分<Gensini积分≤32分,44例),G3组(32分<Gensini积分≤64分,35例)和G4组(Gensini积分>64分,39例),冠状动脉狭窄<20%则为G0组(95例)。经Spearman和Pearson相关性分析法分析Gensini积分与HCY及冠心病其他危险因素的相关性。Logistic回归分析HCY与Gensini积分、急性心肌梗死(AMI)的关系。结果共入组253例患者,平均年龄(41.7±3.5)岁。5组间的男性比例、吸烟率、空腹血糖(FBG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和HCY平均有显著差异(均为P<0.05)。与Gensini积分有关的危险因素包括男性、吸烟、TC≥5.60 mmol/L、LDL-C≥2.59 mmol/L、FBG≥6.20 mmol/L和HCY≥15.0μmol/L(均为P<0.05)。Logistic回归分析发现,Gensini高积分相关因素有HCY<15.0μmol/L(OR=-1.437,95%CI:-2.355^-0.518,P=0.002)、FBG<6.20 mmol/L(OR=-1.178,95%CI:-2.084^-0.271,P=0.011)和不吸烟(OR=-0.865,95%CI:-1.685^-0.045,P=0.039)。而发生AMI的影响因素有HCY≥15μmol/L(OR=3.907,95%CI:1.794~8.507,P=0.001)、吸烟(OR=5.535,95%CI:2.630~11.651,P<0.001)、LDL-C≥2.59 mmol/L(OR=2.318,95%CI:1.014~5.299,P=0.046)和FBG≥6.20 mmol/L(OR=5.295,95%CI:2.195~12.777,P<0.001)。结论高HCY水平与冠状动脉Gensini高积分显著正相关,并增加AMI的发生风险。Objective To analyze the correlation between coronary artery Gensini score and plasma homocysteine(HCY)in patients with coronary heart disease aged≤45 years.Methods Patients who underwent coronary angiography in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1,2014 to June 30,2018 and were aged≤45 years were retrospectively enrolled.The clinical characteristics were analyzed and the degree of coronary artery stenosis was calculated by Gensini calculation method.According to the interquartile range of Gensini points,patients were divided into the the following groups,G1 group(Gensini points≤14,40 cases),G2 group(14<Gensini points≤32,44 cases),G3 group(32<Gensini points≤64,35 cases)and G4 group(Gensini points>64,39 cases);besides,those with coronary artery stenosis<20%were considered as the G0 group(95 cases).Spearman and Pearson correlation analyses was used to analyze the correlation between Gensini score and HCY and other risk factors of coronary heart disease.Logistic regression analysis of the relationship between HCY and Gensini score,acute myocardial infarction(AMI).Results A total of 253 patients were enrolled,with an average age of(41.7±3.5)years.Among the 5 groups,the proportion of males,smoking rate,fasting blood glucose(FBG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and HCY were significantly different(all P<0.05).The risk factors related to Gensini score included male,smoking,TC≥5.60 mmol/L,LDL-C≥2.59 mmol/L,FBG≥6.20 mmol/L,HCY≥15.0μmol/L(all P<0.05).Logistic regression analyses showed that the factors related to Gensini's high score were HCY<15.0μmol/L(OR=-1.437,95%CI:-2.355 to-0.518,P=0.002),FBG<6.20 mmol/L(OR=-1.178,95%CI:-2.084 to-0.271,P=0.011)and non-smoking(OR=-0.865,95%CI:-1.685 to-0.045,P=0.039).The risk factors of AMI were HCY≥15μmol/L(OR=3.907,95%CI:1.794 to 8.507,P=0.001),smoking(OR=5.535,95%CI:2.630 to 11.651,P<0.001),LDL-C≥2.59 mmol/L(OR=2.318,95%CI:1.014 to 5.299,P=0.046)and FBG≥6.20 mmol/L(OR=5.295,95%CI:2.195 to

关 键 词：冠心病 GENSINI积分 同型半胱氨酸 急性心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]