同型半胱氨酸与不稳定型心绞痛患者介入治疗早期并发症的关系

Predictive value of homocysteine for early complications in UAP patients with percutaneous coronary intervention

目的:观察不稳定型心绞痛(UAP)患者经皮冠状动脉介入治疗(PCI)后早期并发症的发生情况,检测术前同型半胱氨酸(Hcy)水平及PCI前、术后v WF、白细胞介素-8(IL-8)、一氧化碳(NO)水平,探讨Hcy与PCI早期并发症的关系及可能的作用机制。方法:选择88例行PCI UAP患者,分别于术前、术后30min、4h、12h、24h、48h、72h、7d取外周静脉血,采用酶联免疫吸附双抗夹心法测定Hcy、v WF、IL-8,利用硝酸还原酶法测定NO。结果:88例患者PCI术后心脏早期并发症总发生率为12·5%。早期并发症组患者术前Hcy、v WF和IL-8水平显著高于非早期并发症组(均P<0·05),NO水平显著低于非早期并发症组(P<0·05)。早期并发症组患者术后v WF和IL-8峰值水平显著高于无早期并发症组(均P<0·05),术后NO最低值低于非早期并发症组,但两者相比差异无统计学意义(P>0·05)。Hcy水平与v WF、IL-8术前、术后峰值水平呈正相关(r=0·634,P<0·01;r=0·534,P<0·01;r=0·597,P<0·01;r=0·544,P<0·01),与NO术前、术后低值水平呈负相关(r=-0·568,P<0·01、r=-0·148,P>0·05)。多变量Logistic回归分析,术前Hcy水平(RR=1·225,CI=1·059-1·418,P<0·01),糖尿病(RR=1·712,CI=1·128-2·898,P<0·05)是PCI早期并发症的独立预测因子。结论:①Hcy水平与PCI术后早期并发症密切相关,随着Hcy水平升高,早期并发症有显著增高趋势。②血浆Hcy可能通过影响IL-8、v WF水平导致早期并发症的出现。③Hcy水平对PCI术后早期并发症具有独立预测价值。

Objective：This study aims to investigate the predictive value of homocysteine for early complication in UAP patients with PCI. Method：The study population consisted of 88 patients who underwent PCI. Peripheral blood samples were taken before and 30 min, 4 h, 12 h, 24 h, 48 h, 72 h, 7 d after PCI. Hcy,vWF, and IL-8 were assayed with Enzyme-linked Immunometric Assay, NO was analyzed with Nitrate Reductase Assay. Result： Incidence of early complications in this group of patients is 12.5M. Before PCI, the levels of Hcy, IL-8, vWF were significantly higher in patients with early complications than those without early complications （ P 〈0.05）, the level of NO was lower in patients with early complications than those without early complications （ P 〈0. 05）. Hcy levels were positively correlated with IL-8 and vWF, but negatively correlated with NO. Levels of Hcy and diabetes were the independent predictors of early complications after PCI （ RR = 1. 225, CI = 1. 059-1. 418, P 0.01, RR =1. 712, CI 1. 128-2. 898, P 〈0.05）. Conclusion：①Hcy is related to early complications of PCI. The higher levels of Hcy were, the higher incidence of early complications ②Hcy perhaps influences levels of IL-8 and vWF and contributes to early complications. ③Preprocedural levels of Hcy are powerful independent predic tors of early complications.