同型半胱氨酸与冠心病相关性的临床研究

The correlation between serum homocysteine and coronary heart disease

目的:探讨血清同型半胱氨酸( HCY)水平与冠心病( CHD)的关系。方法:采用荧光偏振免疫分析法( FPIA)对1 5 3例行冠状动脉造影患者测定HCY水平。冠脉造影显示3支冠脉中至少1支血管病变狭窄≥5 0 %者为CHD组( 1 0 5例) ,3支血管中任一血管狭窄程度均<5 0 %者为对照组( 4 8例)。CHD患者进一步分为1支病变组( 2 5例) ,2支病变组( 31例)及3支病变组( 4 9例)。结果:1 CHD组血清HCY水平明显高于对照组( P<0 .0 0 1 ) ,且CHD组中高HCY血症发生率明显高于对照组( P<0 .0 0 1 ) ;2 0、1、2、3支血管病变者血清HCY浓度呈逐级增高趋势,0支病变组与其它各病变组间比较均相差非常显著( P<0 .0 0 1 ) ,1支、2支、3支病变组间差异无统计学意义;3不同临床类型患者,HCY水平急性心肌梗死( AMI) >陈旧性心肌梗死( OMI) >不稳定型心绞痛( UAP) >稳定型心绞痛( SAP)>其它( Other) ,其中AMI组与UAP组相比较差异显著( P<0 .0 1 )、AMI与SAP组、AMI与Other组间比较均有显著性显著( P<0 .0 0 1 )。结论:CHD患者血清HCY水平明显增高,高HCY血症所占比例较大,且血清HCY浓度随冠脉病变程度加重呈上升趋势,CHD活动性病变较稳定性病变HCY浓度增高,提示HCY与冠状动脉病变的发生发展可能有直接关系。

Objective: To investigate the correlation between serum homocysteine(HCY) level and coronary heart disease(CHD).Methods: 153 subjects who underwent coronary angiography were recruited in this study. Cases(n=105) with ≥50% stenosis in at least one of the three coronary vessels were angiographically defined as having coronary heart disease(CHD).While subjects(n=48) with <50% in all the three coronary vessels were considered as controls. CHD cases were divided into single-vessel(n=25),double-vessel(n=31)and triple-vessel group(n=49). The fluorescence polarization immunoassay (FPIA) was used to assess the level of serum HCY in the patients. Results: ① Serum HCY level was significantly higher in the CHD group than in the control [(22.89±13.31)μmol/L versus (10.33±3.44)μmol/L, P <0.001].In the CHD group, 58.10% of the patients were found to have Hyperhomocysteinemia, significantly higher than in the control(16.67%, P <0.001);②In patients with lesions in 0, 1, 2 and 3 vessels, their HCY level tended to increase, with the number of vessel involved .A significant discrepancy was found between HCY levels in the control group and in any of the CHD group(single-vessel, double-vessel or triple-vessel group) ,but no discrepancy was found between HCY levels in single-vessel, double-vessel or triple-vessel group; ③HCY was also associated with diagnostic classifications, which was higher in diseases with active lesions (AMI> OMI>UAP>SAP>Other).(AMI versus UAP, P <0.01; AMI versus SAP , P <0.001; AMI versus Other , P <0.001).Conclusion:HCY level is significantly elevated in population with CHD and the incidence of hyperhomocysteinemia is also higher. Higher level of HCY is associated with increased number of coronary arteries with stenosis. HCY level of patients with active lesions is higher than that of patients with inactive lesions. HCY is directly related to the initiation and development of coronary lesions, and is a risk factor for coronary lesions.