血浆同型半胱氨酸对冠心病患者中心动脉压及主要不良心脑血管事件的影响  

Effect of plasma homocysteine on central arterial pressure and major adverse cardiac cerebrovascular events in patients with coronary heart disease

作　　者：高宗鹏 张艺铭 辛林泽 许耀[1] GAO Zong-peng;ZHANG Yi-ming;XIN Lin-ze(Department of Cardiovascular Medicine,Yantai Municipal Laiyang Central Hospital,Yantai 265200,China)

机构地区：[1]烟台市莱阳中心医院心血管内科,265200 [2]武汉科技大学医学院公共卫生学院,430070

出　　处：《中国实用医药》2024年第11期6-10,共5页China Practical Medicine

基　　金：烟台市科技创新发展计划政策引导类(项目编号:2022YD120),项目名称:同型半胱氨酸对经皮冠状动脉介入治疗的冠心病患者预后影响。

摘　　要：目的探讨血浆同型半胱氨酸(Hcy)对冠心病(CHD)患者中心动脉压(CAP)及主要不良心脑血管事件(MACCE)的影响。方法115例冠状动脉造影确诊为冠心病的患者,根据血浆Hcy水平不同分为正常Hcy组(Hcy≤15μmol/L,66例)和高Hcy组(Hcy>15μmol/L,49例)。比较两组的临床资料;分析血浆Hcy与血压[中心动脉收缩压(CASP)、中心动脉舒张压(CADP)、中心动脉脉压(CAPP)、肱动脉收缩压(SBP)、肱动脉舒张压(DBP)及肱动脉脉压(PP)]的相关性;采用Kaplan-Meier法绘制患者生存曲线,分析不同因素影响下CHD患者的生存预后;采用COX回归模型分析CHD患者发生MACCE的危险因素。结果高Hcy组高血压占比、2支及以上病变占比、血尿酸、Hcy、CASP、CADP、CAPP、SBP及DBP分别为71.43%、71.43%、(345.10±95.22)μmol/L、(20.37±3.72)μmol/L、(140.08±20.17)mm Hg(1 mm Hg=0.133 kPa)、(83.22±11.83)mm Hg、(56.86±14.17)mm Hg、(137.18±20.41)mm Hg、(84.14±13.19)mm Hg,均高于正常Hcy组的43.94%、45.45%、(307.79±77.36)μmol/L、(10.69±2.76)μmol/L、(123.83±18.01)mm Hg、(77.61±9.51)mm Hg、(46.23±14.72)mm Hg、(127.67±17.45)mm Hg、(77.47±10.84)mm Hg(P<0.05)。Pearson相关分析显示:血浆Hcy与CASP(r=0.331,P=0.000<0.001)、CADP(r=0.291,P=0.002<0.05)、CAPP(r=0.237,P=0.011<0.05)、SBP(r=0.259,P=0.005<0.05)、DBP(r=0.324,P=0.000<0.001)呈正相关;血浆Hcy与PP无相关性(r=0.100,P=0.290>0.05)。Kaplan-Meier生存曲线分析结果显示:高Hcy水平、CAPP≥50 mm Hg及PP≥52 mm Hg患者MACCE发生风险增加(χ2=6.714、8.741、4.594,P=0.010、0.003、0.032<0.05)。多因素COX回归分析结果显示:糖尿病及CAPP是冠心病患者发生MACCE的独立危险因素(P<0.05)。结论血浆Hcy与CAP水平关系密切,CAPP和糖尿病是CHD患者发生MACCE的独立危险因素。Objective To explore the effect of plasma homocysteine(Hcy)on central arterial pressure(CAP)and major adverse cardiac cerebrovascular events(MACCE)in patients with coronary heart disease(CHD).Methods 115 patients with CHD confirmed by coronary angiography were divided into normal Hcy group(Hcy≤15μmol/L,66 cases)and high Hcy group(Hcy>15μmol/L,49 cases)according to different plasma Hcy level,and the clinical data of the two groups were compared.The correlation between plasma Hcy and blood pressure[central artery systolic pressure(CASP),central artery diastolic pressure(CADP),central artery pulse pressure(CAPP),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)]was analyzed.The Kaplan-Meier method was used to draw patient survival curves and analyze the survival prognosis of CHD patients under the influence of different factors;the COX regression model was used to analyze the risk factors for MACCE in CHD patients.Results In the high Hcy group,the percentage of hypertension,the percentage of lesions with two or more branches,the blood uric acid,Hcy,CASP,CADP,CAPP,SBP and DBP were 71.43%,(345.10±95.22)μmol/L,(20.37±3.72)μmol/L,and(140.08±20.17)mm Hg(1 mm Hg=0.133 kPa),(83.22±11.83)mm Hg,(56.86±14.17)mm Hg,(137.18±20.41)mm Hg and(84.14±13.19)mm Hg,which were higher than 43.94%,45.45%,(307.79±77.36)μmol/L,(10.69±2.76)μmol/L,(123.83±18.01)mm Hg,(77.61±9.51)mm Hg,(46.23±14.72)mm Hg,(127.67±17.45)mm Hg and(77.47±10.84)mm Hg in the normal Hcy group(P<0.05).Pearson correlation analysis showed that plasma Hcy was positively correlated with CASP(r=0.331,P=0.000<0.001),CADP(r=0.291,P=0.002<0.05),CAPP(r=0.237,P=0.011<0.05),SBP(r=0.259,P=0.005<0.05)and DBP(r=0.324,P<0.001).There was no correlation between plasma Hcy and PP(r=0.100,P=0.290>0.05).Kaplan-Meier survival curve analysis showed that patients with high Hcy level,CAPP≥50 mm Hg and PP≥52 mm Hg had an increased risk of MACCE(χ2=6.714,8.741,4.594;P=0.010,0.003,0.032<0.05).Multivariate COX regression analysis showed

关 键 词：同型半胱氨酸 冠心病 中心动脉压 主要不良心脑血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]