冠心病与同型半胱氨酸白介素-6 C-反应蛋白相关性研究

Analysis on the relationship of coronnary heart disease with homocysteine,interleukin-6 and c-reactive protein

目的探讨冠心病与冠心病患者血浆同型半胱氨酸(HCY),血清白介素-6(IL-6)、C-反应蛋白(CRP)含量是否具有相关性;探讨急性心肌梗死发生时同型半胱氨酸、白介素-6、C-反应蛋白的含量是否明显升高;探讨同型半胱氨酸、白介素-6、C-反应蛋白与冠脉病变程度是否具有相关性。方法入选对象为2004年12月至2006年1月在胜利油田中心医院心内科住院疑似冠心病(CHD)、急性心肌梗塞(AMI)、心绞痛(anginapectoris)病人共92例,年龄27～77(平均57±9.66)岁。入选病人择期或急诊行冠脉造影术(CAG)检查,冠脉造影一支冠状动脉血管狭窄≥50%,诊断为冠心病。冠脉造影一支血管狭窄<50%的冠状动脉粥样硬化的患者行冠脉内超声检查,如果一支冠状动脉血管横截面积狭窄≥75%,共同组成冠心病组。共62例,年龄为34～77,平均(59.27±9.65)岁,男性53例,女性9例。冠脉造影阴性为对照组,共30例,年龄27～72,平均(54.73±9.68)岁,男性21例,女性9例。冠心病组中急性心肌梗死16例,心绞痛46例作为冠心病的2个亚组。冠脉造影结果根据冠脉病变程度不同分别为1、2、3支病变组来作为冠心病的3个亚组,对每个病人进行冠脉病变狭窄程度计分。入院第二天清晨采空腹静脉血9ml,或急诊冠脉造影术前采静脉血9ml均分3份分别送生化室及免疫室,分别用酶免法、双抗体夹心ELISA法、免疫比浊法测得同型半胱氨酸、白介素-6、C-反应蛋白水平。处理采用SPSS10.0软件包进行统计学分析。结果冠心病组血浆HCY(P<0.02);IL-6明显高于对照组(P<0.001);血清CRP明显高于对照组(P<0.002)。冠心病组中急性心肌梗死组与非梗死组之间HCY比较无统计学意义(P>0.05);IL-6明显高于非心肌梗死组(P<0.01);CRP明显高于非梗死组(P<0.01)。HCY与冠脉病变积分有相关性(r=0.277,P<0.05);CRP与冠脉病变积分有相关性(r=0.2699,P<0.05);IL-6与冠脉病变积分有相关性(r=0.343,P<0.001)。结论同型半胱氨酸、白介素-6、C-反应蛋白是冠心病危险程度预测因子,急性心肌梗死患者、IL-6、CRP明显升高,HCY、IL-6、CRP与冠脉病变严重程度相关。

Objective To elucidate whether the plasma concentration of homocysteine,serum interleukin-6 and C-reactive protein correlated with CHD.To elucidate whether concentration of homocysteine,interleukin—6 and C-reactive protein in AMI were higher than that of patients without AMI in CHD.To elucidate whether there were close correlation in HYC,IL-6,CRP and coronary stenosis.To study whether concentration of HCY,IL-6and CRP were increased with extent of disease.Methods Subjects came from of the central hospital of Sengli oil plant from December 2004 to January 2006,who entered the department of circulation and aged 27～77(mean 57±9.67) years.The totals of patient were 92 that included doubled CHD,AMI and angina pectoris.All patients underwent CAG.If one branch was obstructed≥50%,the patient was diagnosed CHD.If one branch was obstructed<50%,then these patients underwent Intravascular Ultrasound(IVUG).If one branch of area was obstructed≥75%,these patients were also diagnosed CHD.Positives composed the group of CHD,that included 62 patients and included 53 males and 9 females in CHD group,aged 34～77(mean 59.27±9.65)years.Negatives composed control group,that included 30 patients and included 21 males and 9 females in control class,aged 27～72(mean 54.73±9.68) years.There were 16 AMIs and 46 angina patientses in CHD group.The grade and type of coronary atherosclerosis were scored from the angiographic data retrieved in digital format CD-ROM by counting the number of affected vessels and by calculating astenosis.Blood of vein was draw from patients next morning or before CAG and sent to test concentrations of HCY,IL-6 and CRP by different method.All statistical analyses were carried out using the statistical SPSS10.0 package.Results Concentrations of HCY,IL-6 and CRP were significantly higher than that of control group(P<0.02,P<0.001,P<0.002).In CHD the concentration of HCY was no difference in AMI with that of patients without AMI(P>0.05).Concentration of IL-6 and CRP were significantly higher in AMI than that of patients without AMI(P<0.01,P<0.01).Levels of HCY,IL-6 and CRP showed a significant positive correlation with the extent of coronary stenosis(P<0.01,P<0.01,P<0.01).Conclusions Coronary heart disease correlated with HCY,IL-6 and CRP.Levels of HCY,IL-6 and CRP showed a significant positive correlation with the extent of coronary stenosis.