同型半胱氨酸与冠状动脉病变关系的分析

Logistic regression model for the relationship between serum homocysteine and coronary atherosclerosis

目的 了解血清同型半胱氨酸 (Hcy)、叶酸及维生素 (Vit)B12 水平与冠心病的关系。方法 用断面调查的方法收集经冠状动脉造影确诊的冠心病患者 2 0 9例、非冠心病患者 116例 ,用高效液相色谱法测定血清同型半胱氨酸水平 ,用放免法测定血清叶酸及VitB12 水平。结果 冠状动脉粥样硬化病变的发生与男性、年龄大、吸烟、糖尿病及血清同型半胱氨酸升高明显相关 ,与叶酸及VitB12 水平的降低明显相关 ,并发现叶酸、VitB12 与同型半胱氨酸之间存在多元共线性。结论 血清Hcy升高和罹患糖尿病、男性、年龄大和吸烟是导致冠心病的重要而各自独立的危险因素。叶酸和VitB12

Objective To study the relationship of serum levels of homocysteine (Hcy), folic acid and vitamin B 12 with coronary atherosclerosis. Methods In a cross sectional study, serum Hcy levels of 209 cases with coronary heart disease (CHD) and 116 subjects without CHD were measured by using high performance liquid chromatography (HPLC) with fluorescence detection. Serum folic acid and vitamin B 12 levels were measured with radioassay method. Results The occurrence of coronary atherosclerosis was related with male sex, smoking, diabetes, folic acid, vitamin B 12 and Hcy level. The mean serum Hcy level was significantly higher in the CHD patients than in the controls [(19.0±10.4)μmol/L, n =209 vs (11.5±5.0) μmol/L, n =116, P <0.01)]. The mean serum levels of folic acid and vitamin B 12 were significantly lower in the patients [(4.5±1.5) μg/L vs (414.6±142.3) ng/L] than the controls [(5.6±1.4) μg/L vs (535.8±135.8) ng/L, P <0.01]. Patients with diabetes and high Hcy level had more severe coronary atherosclerosis than in controls. By multivariate logistic regression, the odds ratios of Hcy level, increased age, smoking and diabetes were all ≥1, P <0.01. It means that they are independent factors for the occurrence of coronary atherosclerosis. When folic acid, vitamin B 12 and Hcy entered the regression model with forward method, the coefficients of Hcy changed greatly, showing multivariate co linearity on logistic regression. Conclusion It is shown that Hcy level, male sex, increased age and diabetes all are independent risk factors for the occurrence of atherosclerosis. Hcy, vitamin B 12 and folic acid have similar affects in this respect.