心绞痛患者血浆同型半胱氨酸水平变化

Changes of the plasma level of homocysteine in patients with angina

目的:观察心绞痛患者血浆同型半胱氨酸水平变化情况及一氧化氮、血管性血友病因子、白细胞介素8水平在冠状动脉病变稳定性中的作用。方法:①选择2002-10/2003-10河北省人民医院心脏中心住院心绞痛患者96例,其中不稳定型心绞痛患者56例(不稳定型心绞痛组),稳定型心绞痛患者40例(稳定型心绞痛组)。选择同期本院心脏中心住院冠状动脉造影正常患者20例为对照组。均对实验目的知情同意。②采用酶联免疫吸附法分别测定血浆同型半胱氨酸、白细胞介素8水平、血清血管性血友病因子水平,亚硝酸还原酶法测定血浆一氧化氮水平。③首先进行组间均衡性检验,计量资料差异比较采用方差分析,然后再作多组均数的q检验,计数资料采用χ2检验,相关资料分析采用直线相关分析,并进行多元Logistic回归分析。结果:不稳定型心绞痛患者56例和稳定型心绞痛患者40例及冠状动脉造影正常患者20例均进入结果分析。①不稳定型心绞痛组患者的年龄、性别、血脂水平,糖尿病和原发性高血压的发生率与稳定型心绞痛组差异不明显。②不稳定型心绞痛组血液同型半胱氨酸、血管性血友病因子、白细胞介素8水平均显著高于稳定型心绞痛组(P<0.05),且两组均明显高于对照组(P<0.05);不稳定型心绞痛组一氧化氮水平显著低于稳定型心绞痛组,两组均明显低于对照组(P<0.05)。③以不稳定型心绞痛为因变量,年龄、同型半胱氨酸、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高血压、糖尿病、心绞痛家族史及吸烟等均作为自变量,进行多元Logistic逐步回归分析,发现最后进入模型的变量为同型半胱氨酸、低密度脂蛋白胆固醇,同型半胱氨酸对于不稳定型心绞痛的危险性比值(RR)为1.554(95%CI1.134～2.130,P=0.001)。④同型半胱氨酸与血管性血友病因子、白细胞介素8呈显著正相关(r=0.539,0.718,P<0.01),同型半胱氨酸与一氧化氮呈显著负相关(r=-0.4733,P<0.01)。结论:①同型半胱氨酸水平升高可能与不稳定型心绞痛有关,可能通过增强炎性激活,使冠心病患者冠状动脉内病变不稳定。②同型半胱氨酸为冠心病患者病变不稳定的独立危险因素,可作为判定冠心病患者冠状动脉病变稳定性指标之一。

AIM： To observe the changes of the plasma level of homocysteine in patients with angina, and explore the roles of the levels of nitric oxide, yon Willebrand disease factor and interleukin-8 in the stability of coronary arteriopathy. METHODS： ① Between October 2002 and October 2003, 96 inpatients with angina, including 56 cases of unstable angiria pectoris （unstable angina pectoris group） and 40 cases of stable angina pectoris （stable angina pectoris）, and 20 inpatients with normal coronary arteriography （control group） were selected from the Heart Center of Hebei Provincial People＇s Hospital, they all participated in the study voluntarily. At the same time 20 normal patients with normal angiography served as controls. ② The levels of homocysteine in plasma, interleukin-8 and yon Willebrand disease factor in serum were detected with enzyme-linked immunosorbent assay （ELISA）, and the level of nitric oxide in plasma was measured by the method of nitrate reductase. ③ The intergroup balance test was performed firstly, the analysis of variance was applied in comparing the differences of measurement data, and then the q test was conducted for the analysis of multigroup means; the x^2test was applied in the analysis of the enumeration data, related data were analyzed with the linear correlation analysis, and the multivariate regression analysis was also conducted. RESULTS： All the 56 patients with unstable angina pectoris, 40 patients with stable angina pectoris and 20 patients with normal coronary arteriography were involved in the analysis of results. ① The age, gender, levels of blood lipids and the incidence rates of diabetes mellitus and essential hypertension in the stable angina pectoris group were not obviously different from those in the unstable angina pectoris group. ② The levels of homocysteine, yon Willebrand disease factor and interleukin- 8 were significantly higher in the unstable angina pectoris group than in the stable angina pectoris group （P 〈 0.05）, and all were obviously higher than those in the control group （P 〈 0.05）. The level of nitric oxide was significantly lower in the unstable angina pectoris group than in the stable angina pectoris group （P 〈 0.05）, and both were obviously higher than that in the control group （P 〈 0.05）. ③ Taking unstable angina pectoris as the dependent variable, age, homoeysteine, tfiglyceride, total cholesterel, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol, （LDL-C）, hypertension, diabetes mellitus, family history of angina and smoking as the independent variables, the multivariate Logistic stepwise regression analysis showed that the variables that finally entered the model were homocysteine and LDL-C, the risk ratio （RR） of homocysteine to unstable angina pectoris was 1.554 （95%CI： 1.134-2.130, P=0.001）. ④ Homocysteine had significant positive correlation with von Willebrand disease factor and interleukin-8 （r=0.539, 0.718, P 〈 0.01）, but had significartt negative correlation with nitric oxide （r=-0.473 3, P 〈 0.01）. CONCLUSION： ① The increased level of homocysteine may be involved in unstable angina pectoris group, it may unstablize the coronary arteriopathy by enhancing inflammatory activation in patients with coronary heart disease. ② Homocysteine is an independent risk factor for the unstable lesion of patients with coronary heart disease, it can be taken as one of the indexes in judging the stability of coronary arteriopathy in patients with coronary heart disease.