冠心病患者同型半胱氨酸水平与冠状动脉病变SYNTAX评分的相关性分析

Correlation between serum homocysteine level and coronary lesion severity in coronary artery disease patients

目的探讨血清同型半胱氨酸（Hey）水平与冠状动脉病变严重程度的关系。方法回顾性分析2012年1—12月在首都医科大学附属北京安贞医院心内科15病房住院行冠状动脉造影检查的512例冠心病患者的病历资料。根据SYNTAX评分结果分为低危、中危和高危组，分别为172、195和145例。选同期行冠状动脉造影检查结果正常者为正常组（180例）。测定4组患者血清Hey、TC、TG、HDL—C和LDL—C水平；比较各组患者血脂、血清Hey水平的差异，评价血清Hey与血脂和SYNTAX评分的关系；根据血脂和血清Hey结果进行冠心病危险因素分析。结果①中危组及高危组患者TC、LDL—C和血清Hey水平与正常组的差异有统计学意义[中危组TC、LDL—C和血清Hey水平分别为（6．1±0．7）mmol／L、（3．7±1．0）mmol／L和（16．4±2．0）txmol／L，高危组分别为（7．2±0．9）mmol／L、（4．2±1．1）mmol／L和（19．5±1．8）μmol／L，正常组分别为（4．5±0．5）mmol／L、（2．9±0．7）mmo]／L和（10．8±0.4）~mol／L，P〈0．05]，余观察指标的组间差异均无统计学意义（P〉0．05）。②512例患者中血清Hey水平正常者272例，其TC、TG、HDL—C、LDL．C和SYN．TAX评分分别为（5．1±1．1）mmol／L、（1．4±1．1）mmol／L、（1．2±0．3）mmol／L、（3．5±0．9）mmol／L和（19±10）分；血清Hey高水平者240例，其TC、TG、HDL—C、LDL—C和SYNTAX评分分别为（5．1±1．2）mmol／L、（1．4±1．6）mmol／L、（1．2±0．3）mmol／L、（3．5±1．0）mmol／L和（264-11）分。高Hey水平患者SYNTAX评分与Hcy水平正常者的差异有统计学意义（P〈0．05），而正常和高Hey水平患者的TC、TG、HDL—C和LDL—C的差异无统计学意义（P〉0．05）。@Logistic多元回归分析结果显示Hcy、TC、LDL—C与冠心病相关（HmYr=0．24、TC：r=0．32、LDL—C：r=0．26，均P〈0．05）。结论血清Hey水平是冠状动脉病变严重程度的危险因素，随着血清Hey水平的增高，冠状动脉病变程度增加。

Objective To evaluate the correlation between serum homocysteine （Hcy） level and coronary lesion severity in coronary artery disease（CAD） patients. Methods A total of 512 patients receiving coronary angi- ography from January 2012 to December 2012 were retrospectively analyzed. According to SYNTAX score, CAD pa- tients were divided into three groups ： low-risk group （ 172 cases）, middle-risk group （ 195 cases） and high risk group（ 145 cases）. One hundred and eighty cases of normal coronary angiography over the same period were seemed as normal group. Fasting serum Hcy levels, fasting blood lipids including total cholesterol （TC）, triglycerides （TG）, high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C） were deter- mined. Results （1）TC, LDL-C and Hcy were significantly higher in SYNTAX score high-risk group and middle- risk group compared with normal group. There was no statistically significant difference between the normal group and the low-risk group [ TC, LDL-C and Hcy in middle-risk group were ： （6.1 ±0.7 ） mmol/L, （3.7 ± 1.0） mmol/L and （ 16.4 ± 2.0 ） μmol/L ; In high-risk group were （7.2 ± 0.9 ） retool/L, （4.2 ± 1. 1 ） mmol/L and （ 19.5 ±1.8）μmol/L; In normal group were（4.5 ＋0.5）mmol/L, （2.9±0.7） mmol/L and （10.8 ±0.4） μmol/L, P〈 0.05]. （2）272 cases had normal Hcy in 512 CAD patients. TC, TG, HDL-C, LDL-C and SYNTAX of them were （5.1 ± 1.1 ） mmol/L, （ 1.4±1.1 ） retool/L, （ 1.2 ± 0.3 ） mmol/L, （3.5 ± 0.9 ） mmol/L and （ 19 ± 10 ） scores ; in high Hcy group, TC, TG, HDL-C, LDL-C and SYNTAX were （ 5. 1 ± 1.2 ） mmol/L, （ 1.4 ±1.6） retool/L, （ 1.2 ± 0.3 ） mmol/L, （3.5 ± 1.0 ） mmol/L and （ 26 ± 11 ） scores. The SYNTAX score was significantly higher in high Hcy group than in normal group （P 〈 0. 05 ）. （3）Muhivariate Logistic regression analysis indicated that serum Hcy, TC, LDL-C were associated with coronary lesion severity （ Hcy ： r = 0.24, TC ： r = 0.32, LDL-C ： r = 0.26, all P 〈 0. 05）. Conclusions Serum Hcy is the risk factor of coronary lesion severity. With the increased Hcy level, the increase in the degree of coronary artery lesions, represent a greater cardiovascular risk.