测定急性冠状动脉综合征患者血浆同型半胱氨酸的意义

Measurement of plasma homocysteine and its related factors in patients with acute coronary syndrome

目的探讨冠心病(CHD)尤其是急性冠状动脉综合征(ACS)患者血浆同型半胱氨酸(Hcy)及影响因素叶酸、维生素B12等水平变化与冠状动脉病变严重性之间的关系。方法采用荧光偏振免疫分析法、离子捕获免疫分析法及非均相微粒子酶免疫分析法等测定302例CHD患者,包括ACS组202例(急性心肌梗死组132例和不稳定型心绞痛组70例),稳定型心绞痛(SAP)组100例和正常对照组120例的血浆Hcy、叶酸及维生素B12等水平。对冠心病患者的冠状动脉损害行Gensini评分,并比较各组间的差异。结果①ACS组、SAP组Hcy浓度显著高于对照组[(19±12)μmol/L vs (10±6)μmol/L(P<0.01)、(15±5)μmol/L vs (10±6)μmol/L(P<0.01)],而叶酸,维生素B12浓度显著低于对照组[(3.2±0.7)μg/L vs (7.1±1.8)μg/L(P<0.01),(5.3±0.6)μg/L vs (7.1±1.8)μg/L(P<0.01);(184±32)ng/L vs (283±56)ng/L(P<0.01),(228±45)ng/L vs (283±56)ng/L(P<0.01)。并且ACS组和SAP组的血浆同型半胱氨酸和血清叶酸、维生素B12浓度差异也有统计学意义。②血浆Hcy浓度与血浆叶酸、维生素B12浓度呈线性负相关。③随着冠状动脉病变Gensini评分的增加,Hcy浓度明显升高。结论冠心病尤其是ACS患者血浆Hcy显著升高,其升高严重程度与CHD的发生、病情严重性和冠状动脉病变程度有密切关系,检测CHD患者血浆Hcy水平可以预测冠状动脉病变程度,对于高Hcy者应用叶酸,维生素B12治疗,对于延缓CHD尤其是ACS病变发展可能有十分重要的临床意义。

Objective To study the correlation of plasma homocysteine （Hcy）, folic acid （FA）, vitamin B12 with severity of coronary artery lesion in patients with coronary heart disease （CHD）, acute coronary syndrome （ACS） in particular. Methods Plasma Hey concentrations were measured by fluorescence polarization immunoassays （FPIA）, serum folic acid and vitamin B12 concentrations by ion capture immunoassay （ICIA） and mieroparticle enzyme immunoassay （MEIA）, respectively, in 302 patients diagnosed as CHD using coronary artery arteriography. Among these patients, there were 202 cases of ACS （132 of acute myocardial infarction and 70 of unstable angina group） and 100 cases of stable angina pectoris （SAP）. Another 102 healthy individuals were recruited as the control group. All CHD patients were evaluated for their severity of coronary artery lesion using Gensini score. Results ①The plasma Hey in ACS and SAP patients was obviously higher than those in controls [（19±12）μmol/L vs （10±6）μmol/L （P〈0.01） and （15± 5）μmol/L vs （10±6） μmol/L （P〈0.01）]. The serum folic acid and vitamin B12 in ACS and SAP patients were obviously lower than those in controls [（3.2±0.7）μg/L vs （7.1±1.8）μg/L（P〈0.01）, （5.3±0.6）μg/L vs （7.1±1.8）μg/L （P〈0.01）; （184± 32） ng/L vs （283±56） ng/L （P〈0.01）, （228±45） ng/L vs （283±56） ng/L （P〈0.01）]. There was significant differences in levels of Hcy, folic acid and vitamin B12 between ACS and SAP groups （P〈0.01）.②The plasma homocysteine was negatively correlated with concentration of folic acid or vitamin B12. ③The level of plasma homocysteine increased significandy with Gensini score of coronary lesion. Conclusion The level of plasma homocysteine was shown to be elevated in CHD patients and positively correlated with Gensini score of coronary lesion. There was a close relationship between the high level of Hcy and the incidence of ACS. Detection of plasma homocysteine in patients with ACS can be predictive of coronary artery lesion. Patients with hyperhomocysteinemia should benefit from proper supplement of folic acid and vitamin B12 for prevention of ACS progression.