心肌梗死与颈动脉血流动力学及同型半胱氨酸血症的关系

The clinical research on correlation of myocardial infarction to carotid hemodynamics and homocystinemia

目的探讨急性心肌梗死患者与颈动脉血流动力学特征之间的关系以及HCY间的相关性,为心肌梗死的进一步研究提供参考依据。方法选取2012年6月至2015年6月行择期冠脉造影的急性心肌梗死患者120例,并根据患者造影后冠脉病变的严重程度分为了3组:即正常组(造影正常)31例、单支病变组47例、三支病变组42例。测定每组患者的颈动脉血流动力学和同型半胱氨酸水平,观察3组患者的血管搏动指数、舒张末期血流速度、收缩期峰值血流速度及血管阻力指数;同时测定3组患者的TC、TG、LDL-C、HDL-C、UA、Hcy,并比较所有检测值。结果单支病变组、三支病变组中患者的舒张末期血流速度与正常组相比逐渐降低,血管阻力指数与正常组相比则升高,两者间的比较差异有统计学意义(P<0.01);单支病变组中的血管搏动指数低于三支病变组中的指数值,两者间的比较差异有统计学意义(P<0.05),而其他数值间的比较则无统计学意义(P>0.05);3组患者的收缩期峰值血流速度比较差异无统计学意义(P>0.05)。单支病变组、三支病变组中患者的TC、TG、LDL-C、UA、Hcy检测值均显著的高于正常组,而HDL-C的检测值则低于正常组,差异有统计学意义(P<0.01);单支病变组中的UA和Hcy检测值均低于三支病变组的检测值,两组间的检测差异有统计学上意义(P<0.01),而TC、TG、LDL-C的检测值比较无统计学意义(P>0.05)。结论颈动脉血流动力学测定与HCY检测均为临床上检测心肌梗死的一种技术手段,可间接的反映患者心肌梗死的严重程度,对可疑心肌梗死患者行颈动脉血流动力学与HCY检测对疾病的确诊有着重要的临床意义。

Objective To probe the correlation of acute myocardial infarction with the characteristics of carotid hemodynamics and homocystinemia in patients,to provide reference for the further study of the myocardial infarction.Methods 120 patients with acute myocardial infarction and being underwent elective coronary angiography from June 2012 to June 2015 were chosen and divided into three groups according to the severity of coronary angiography：31 cases in normal group（angiographically normal）,47 cases in single vessel group and 42 cases in three-vessel disease group and their pulsatility index（PI）,end diastolic velocity,systolic peak flow velocity and vascular resistance index,as well as TC,TG,LDL-C,HDL-C,UA,and homocysteine were examined,respectively.Results In single-vessel disease group and three-vessel disease group patients,diastolic velocities were gradually decreased,while vascular resistance indexes in disease groups increased,when compared with the normal group,（P〈0.01）;Pulsatility indexes in single-vessel disease group were lower than those in the three-vessel disease group（P〈0.05）;diastolic velocity,systolic peak flow velocity and vascular resistance indexes were not changed.TC,TG,LDL-C,UA and hemocysteine in single-vessel disease group and three-vessel disease group were significantly higher than those in the normal group,while HDL-C were lower than those in the normal group（P〈0.01）;UA and hemocysteine in single-vessel disease group were lower than those in three-vessel disease group（P〈0.01）.Conclusion Carotid hemodynamics and homocysteine can be used in clinical detection of myocardial infarction and can indirectly reflect the severity of patients with myocardial infarction,thus have some clinical significance for diagnosis of the disease.