血Hcy、MIF、Fg水平与冠心病患者冠状动脉粥样病变程度关系分析

Relationship between serum Hcy,MIF,Fg level and severity of coronary atherosclerosis in patients with coronary heart disease

目的探讨血同型半胱氨酸(homocysteine,Hcy)、巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MIF)、纤维蛋白原(fibrinogen,Fg)水平与冠心病患者冠状动脉粥样病变程度的关系。方法选取2017年12月至2018年12月在徐州市中心医院行冠脉造影的患者220例,根据冠脉造影结果分为冠心病组(n=150)和非冠心病组(n=70),根据冠脉造影情况评估冠脉病变程度,Spearman等级相关性分析和Pearson线性相关性分析检验血Hcy、MIF、Fg水平与冠脉病变程度和Gensini积分的关系。Logistic回归分析检验Hcy、MIF、Fg水平对冠心病的影响。结果冠脉正常患者、单纯冠脉斑块患者、单支病变患者、双支病变患者、三支病变患者、冠脉闭塞患者血Hcy、MIF、Fg水平分别为(10.63±1.98)μmol/L、(13.91±2.33)μmol/L、(16.59±4.32)μmol/L、(19.65±4.65)μmol/L、(23.64±5.32)μmol/L、(26.98±5.63)μmol/L、(81.15±20.15)pg/mL、(100.62±20.35)pg/mL、(126.71±28.54)pg/mL、(149.25±29.63)pg/mL、(172.68±31.59)pg/mL、(200.31±41.36)pg/mL、(2.05±0.34)g/L、(3.28±1.14)g/L、(4.04±1.22)g/L、(4.56±1.68)g/L、(5.11±1.78)g/L、(5.34±1.98)g/L,呈逐渐升高趋势(与冠脉正常Hcy、MIF、Fg水平比较,t_(单纯-Hcy)=5.719、t_(单支-Hcy)=6.183、t_(双支-Hcy)=8.678、t_(三支-Hcy)=10.921、t_(闭塞-Hcy)=12.890、t_(单纯-MIF)=3.727、t_(单支-MIF)=6.793、t_(双支-MIF)=9.678、t_(三支-MIF)=11.956、t_(闭塞-MIF)=12.478、t_(单纯-Fg)=4.943、t_(单支-Fg)=7.501、t_(双支-Fg)=6.910、t_(三支-Fg)=7.940、t_(闭塞-Fg)=7.684,P值均<0.05;与单纯冠脉粥样硬化比较,t_(单支-Hcy)=3.815、t_(双支-Hcy)=7.561、t_(三支-Hcy)=15.151、t_(闭塞-Hcy)=13.943、t_(单支-MIF)=5.224、t_(双支-MIF)=9.205、t_(三支-MIF)=12.347、t_(闭塞-MIF)=13.758、t_(单支-Fg)=3.211、t_(双支-Fg)=4.291、t_(三支-Fg)=5.577、t_(闭塞-Fg)=5.606,P值均<0.05;与单支病变比较,t_(双支-Hcy)=3.320、t_(三支-Hcy)=6.589、t_(闭塞-Hcy)=8.834、t_(双支-MIF)=3.766、t_(三支-MIF)=6.820、t_(闭塞-MIF)=9.021、t_(双支-Fg)=2.244、t_(三支-Fg)=3.246、t_(闭塞-Fg)=3.943,P值均<0.05;与双支病变比较,t_(三支-Hcy)=3.428、t_(闭塞-Hcy)=5.732、t_(三支-MIF)=3.264、t_(闭塞-MIF)=5.852、t_(三支-Fg)=2.931、t_(闭塞-Fg)=2.351,P值均<0.05;与三支病变比较,t_(闭塞-Hcy)=2.251、t_(闭塞-MIF)=2.811、t_(闭塞-Fg)=2.103,P值均<0.05),血Hcy、MIF、Fg水平与冠脉病变程度和Gensini积分呈正相关(P值分别为0.003、0.003、0.002、0.004、0.003、0.002);总胆固醇、甘油三酯、Hcy、MIF、Fg是冠心病的独立危险因素。结论血Hcy、MIF、Fg高水平是冠心病的独立危险因素,能很好的反映冠心病患者冠状动脉粥样病变程度,对指导临床治疗有一定参考价值。

Objective To study the relationship between serum homocysteine(Hcy),macrophage migration inhibitory factor(MIF),fibrinogen(Fg)levels and severity of coronary atherosclerosis in patients with coronary heart disease(CHD).Methods A total of 220 patients who underwent coronary angiography in Xuzhou Gentral Hospital from December 2017 to December 2018 were enrolled.According to coronary angiography results,they were divided into CHD group(n=150)and non-CHD group(n=70).According to coronary angiography conditions,severity of coronary atherosclerosis was evaluated.Spearman rank correlation analysis and Pearson linear correlation analysis were performed to test relationship between serum Hcy,MIF,Fg levels and severity of coronary atherosclerosis,Gensini score.Logistic regression analysis was performed to test effects of Hcy,MIF and Fg levels on CHD.Results The blood Hcy,MIF and Fg levels were(10.63±1.98)μmol/L,(13.91±2.33)μmol/L,(16.59±4.32)μmol/L,(19.65±4.65)μmol/L,(23.64±5.32)μmol/L,(26.98±5.63)μmol/L,(81.15±20.15)pg/mL,(100.62±20.35)pg/mL,(126.71±28.54)pg/mL,(149.25±29.63)pg/mL,(172.68±31.59)pg/mL,(200.31±41.36)pg/mL,(2.05±0.34)g/L,(3.28±1.14)g/L,(4.04±1.22)g/L,(4.56±1.68)g/L,(5.11±1.78)g/L,(5.34±1.98)g/L in patients with normal coronary arteries,patients with simple coronary plaque,patients with single branch lesions,patients with double branch lesions,patients with triple branch lesions and patients with coronary occlusion,respectively,all showed a gradually increasing(compared with normal Hcy,MIF and Fg levels in coronary arteries,tsimple-Hcy=5.719,t_(single-branch-Hcy)=6.183,t_(double-branch-Hcy)=8.678,t_(triple-branch-Hcy)=10.921,t_(occluded-Hcy)=12.890,t_(simple-MIF)=3.727,t_(single-branch-MIF)=6.793,t_(double-branch-MIF)=9.678,t_(triple-branch-MIF)=11.956,t_(occlusion-MIF)=12.478,t_(simple-branch-Fg)=4.943,t_(single-branch-Fg)=7.501,t_(double-branch-Fg)=6.910,t_(triple-branch-Fg)=7.940,and t_(occlusion-Fg)=7.684,all P values<0.05;compared with simple coronary atherosclerosis,t_(single-branch-Hcy)=3.815,t_(double-branch-Hcy)=7.561,t_(triple-branch-Hcy)=15.151,t_(occluded-Hcy)=13.943,t_(single-branch-MIF)=5.224,t_(double-branch-MIF)=9.205,t_(triple-branch-MIF)=12.347,t_(occlusion-MIF)=13.758,t_(single-branch-Fg)=3.211,t_(double--branch-Fg)=4.291,t_(triple-branch-Fg)=5.577,t_(occlusion-Fg)=5.606,all P values<0.05;compared with single-branch lesions,t_(double-branch-Hcy)=3.320,t_(triple-branch-Hcy)=6.589,t_(occluded-Hcy)=8.834,t_(double-branch-MIF)=3.766,t_(triple-branch-MIF)=6.820,t_(occlusion-MIF)=9.021,_(double--branch-Fg)=2.244,t_(triple-branch-Fg)=3.246,t_(occlusion-Fg)=3.943,all P values<0.05;compared with double-branch lesions,t_(triple-branch-Hcy)=3.428,t_(occluded-Hcy)=5.732,t_(triple-branch-MIF)=3.264,t_(occlusion-MIF)=5.852,t_(triple-branch-Fg)=2.931,t_(occlusion-Fg)=2.351,all P values<0.05;compared with triple-branch lesions,t_(occluded-Hcy)=2.251,t_(occlusion-MIF)=2.811,t_(occlusion-Fg)=2.103,all P values<0.05),blood Hcy,MIF,and Fg levels were correlated with the degree of coronary lesions and Gensini score were positively correlated(P=0.003,0.003,0.002,0.004,0.003,0.002).Total cholesterol,triglyceride,Hcy,MIF and Fg were independent risk factors for CHD.Conclusion High levels of serum Hcy,MIF and Fg are independent risk factors for CHD,which can reflect degree of coronary atherosclerosis in CHD patients,which are of certain reference value for guiding clinical treatment.