同型半胱氨酸、S-腺苷同型半胱氨酸及其联合检测对冠心病预测价值的探讨

Predictive value of homocysteine in combination with s-adenosylhomocysteine in coronary artery disease

目的检测冠心病(CAD)患者血浆S-腺苷同型半胱氨酸(SAH)、同型半胱氨酸(Hcy)与冠状动脉病变程度的关系,并探讨Hcy、SAH及其联合检测对冠心病的预测价值,为冠心病诊治提供依据。方法选择胸痛和疑似CAD的患者(n=250,年龄40~80岁)接受冠状动脉造影(CAG)检查评估冠状动脉狭窄程度,冠脉病变程度采用Gensini积分系统。将患者分别分配到正常冠脉对照组和CAD组。收集患者空腹全血,测定血浆Hcy、SAH和S-腺苷甲硫氨酸(SAM)浓度,计算SAH/SAM比值。采用Spearman相关分析评估血浆Hcy、SAM、SAH浓度及SAH/SAM比值与冠脉病变严重程度(Gensini积分)之间的相关性;采用多元Logistic回归分析上述指标对CAD患病的影响;绘制受试者工作特征(ROC)曲线,评价Hcy、SAM、SAH浓度,SAH/SAM比值及Hcy、SAH两者联合检测对CAD的预测价值。结果CAD患者血浆Hcy、SAH浓度,SAH/SAM比值水平明显高于对照组。CAD组患者SAH/SAM(r=0.388,P<0.05)与Gensini评分呈正相关,血浆SAH浓度(r=0.634,P<0.05)与Gensini评分也存在着更强的正相关。CAD组血浆Hcy、SAM浓度,以及对照组上述指标与Gensini评分相关性均无统计学意义(P>0.05)。逐步Logistic回归分析结果显示,血浆Hcy、SAH、SAH/SAM水平升高是CAD患病的独立危险因素(OR值分别为1.07、1.1、38.7,P<0.05)。Hcy、SAH、SAH/SAM各单独预测冠心病时的ROC曲线下面积分别为0.62.6、0.768和0.572,而Hcy和SAH两者联合预测CAD的ROC曲线下面积为0.780,但并未显示出比SAH单独诊断CAD更优。结论血浆SAH可能是比Hcy更好的诊断冠心病的预测指标,而且能预测冠脉病变严重程度。该方法简便易行,可为CAD的早期诊断及预防提供参考依据。

Objective To evaluate the relationships between plasma homocysteine(Hey),S-adenosylhomocysteine(SAH)and the severity of coronary artery lesions and explore the predictive value of homocysteine combined with S-adenosylhomocysteine for coronary artery disease(CAD),and provide reference for diagnosis and treatment of C.AD.Methods Participants(n=250;aged 40-80 years)with chest pain and suspected C.AD underwent coronary angiography(GAG)for assessment of coronary artery stenosis,who were assigned to either the control subjects or CAD group.Fasting blood was collected before plasma Hey,SAH and S-adenosylmethionine(SAM)concentrations were measured.Spearman correlation analysis was used to evaluate the relationships between plasma Hey,SAH,SAM and SAH/SAM and the severity of coronary artery lesions assessed by Gensini score.The impact of Hey,SAH,SAM and SAH/SAM on CAD was analyzed by multiple Logistic regression.ROCanalysis was conducted to evaluate the values of Hey,SAH,SAH/SAM and combination of Hey and SAH in predicting CAD.Results In CAD patients,LTL(T/S ratio)was significantly negatively correlated with the level of blood 8-OxoG(r=-0.527,P<0.001)and the level of Hcy(r=-0.614,P<0.001),and plasma Hey was significantly positively correlated with blood 8-OxoG(r=0.493,P<0.001).Coronary artery lesions were associated with SAH(r=0.517,P<0.05).Compared with the control subjects,CAD patients had higher levels of Hey,SAH and SAH/SAM(P<0.05).Spearman correlation analysis showed that the Gensini scores had a positive correlation with the SAH/SAM ratio(r=-0.388,P<0.05)and a stronger positive correlation with the level of SAH(r=0.634,P<0.05)in CAD patients.But there was no significant correlation between Gensini scores and Hey,SAM in CAD patients and no index was found to be related to Gensini scores in control subjects.Stepwise Logistic regression analysis showed that increased Hey,SAH,and SAH/SAM were risk factors for CAD(OR=1.07,1.1,38.7,P<0.05).In the process of predicting CAD,AUCs of Hey,SAH,and SAH/SAM were 0.626,0.768 and 0.572,respectively,while that of the combination of Hey and SAH was 0.780,which was not significantly better than when SAH was used alone in predicting CAD.Conclusion To predict CAD,the combination of Hey and SAH is not more effective than SAH alone.Detection of SAH is simple and easy,and can also predict the severity of coronary lesions,which may be a better indicator than Hey as reference for prophase prevention of CAD.