“正常”冠状动脉慢血流现象与血浆同型半胱氨酸水平的相关分析

Elevated level of plasma homocysteine in patients with slow coronary flow

目的:探讨冠状动脉慢血流现象(SCF)与血浆同型半胱氨酸(Hcy)水平的相关关系。方法:选择我院行冠状动脉造影(CAG)显示心外膜主要冠状动脉无明显病变的患者64例。通过校正TIMI血流计帧法(cT-FC)计算各支冠状动脉的TIMI帧数。冠状动脉平均帧数大于27帧定义为SCF,将患者分为SCF组(24例)和对照组(40例)。应用t检验和卡方检验比较2组各项临床资料的差异,并采用多元逐步回归和Logistic回归分析方法对相关因素进行分析。结果:2组患者性别、高血压、糖尿病、吸烟所占比例、血脂水平、血糖水平的差异无统计学意义,而SCF组的Hcy水平显著高于对照组[(12.55±2.65)μmol/L:(8.39±1.98)μmol/L,P<0.001],年龄小于对照组[(53.25±8.67)岁:(57.85±8.08)岁,P=0.036]。多元逐步回归方程:cTFC=9.979+2.256×Hcy-0.14×年龄(F=122.268,P<0.001)。Logistic回归分析表明Hcy是影响SCF的危险因素(OR2.214,P<0.001)。结论:Hcy与SCF有关,Hcy可能参与了SCF发生的病理生理过程。

Objective：To study tee relation between the level of plasma homocysteine and slow coronary flow （SCF） . Method：The study population included 64 patients with angiographically proven normal epicardial coronary arteries. Coronary flow patterns of the cases were determined by the corrected thromholysis in myocardial infarc- tion frame count method （cTFC）. The cTFC was calculated separately for each coronary artery and their average was determined as the mean cTFC for each subject. Patients whose average cTFC greater than 27 were included in the SCF group（n= 24） and the others were included in the control group（n= 40）. Comparison of categorical and continuous variables between the two groups was performed using chi-square test and unpaired t-test. Multivariate analysis evaluating predictors of SCF was performed using regression test. Result：There were no statistical difference between the two groups concerning the gender, history of hypertension, diabetes mellitus and cigarette smoking, fasting plasma glusose and lipid levels . However, the level of plasma homocysteine was significantly higher （12. 55±2.65 μmol/L vs 8.39±1.98 μmol/L,P〈0.001） whereas the age was lower in the SCF（53. 25±8. 67 vs 57.85 ±8. 08, P= 0. 036） compared with the control group. Multivariate regression analysis showed the regression equation：cTFC：9. 979＋2. 256 × homoeysteine --0. 14×age（F=122. 268, P〈0. 001）. The level of plasma homocysteine was proved to be the risk factor of SCF by means of Logistic regression test （OR 2. 214, P〈0. 001）. Conclusion：The elevated level of plasma Hcy in patients with SCF plays an importment role in the pathogenesis of the SCF phenomenon.