糖尿病患者血浆同型半胱氨酸与围术期心血管事件的相关性分析

Correlation between plasma homocysteine levels and perioperative cardiovascular events in patients with diabetes mellitus

目的探讨糖尿病患者血浆同型半胱氨酸(homocysteine,Hcy)水平与围术期心血管事件(PCE)的相关性。方法2011年10月至2012年10月,合并糖尿病的择期非心脏手术患者300例,根据Hcy水平分为N组(Hcy<15.4μmol/L,217例)和H组(Hcy>15.4μmol/L,83例)。记录患者一般临床资料及心血管危险因素,通过动态心电图(DCG)持续监测术后48h的PCE发生情况。结果 59例发生PCE,发生率为19.7%;其中,N组PCE的发生率为15.7%,H组PCE的发生率为30.1%,两组差异有统计学意义(t=7.937,P=0.005);两组患者hs-CRP、LDL、TG浓度和ECG异常比较差异有统计学意义(P<0.05)。结论糖尿病患者Hcy水平与PCE的发生率及心血管危险因素的控制密切相关。

Objective To investigate the correlation between plasma homocysteine （Hcy） levels and perioperative cardio-vascular events （PCEs） in patients with diabetes mel itus undergoing non- cardial surgery. Methods From October 2011 to Oc-tober 2012, 300 diabetic patients underwent elective non- cardiac surgery, including 217 patients with normal plasma Hcy level （Hcy〈15.4μmol/L, group N） and 87 with high Hcy level （Hcy≥15.4μmol/L, group H）. Various risk factors including gender, age, BMI, ASA classification, fasting blood glucose, HbA1c, blood lipids, Hcy and hs- CRP levels, smoking history, hypertension, pre-operative ECG changes, anesthesia method and operative time were documented in al patients. PCEs were monitored by dy-namic electrocardiography（DCG） for 48h after surgery. Results Perioperative PCEs developed in 59 patients （19.7%）. The inci-dences of PCEs were 15.7%and 30.1%in N and H groups, respectively （t=7.937, P=0.005）. Compared with N group, hs- CRP, LDL and TG levels and preoperative ECG changes were higher in H group （P〈0.05）. Conclusion Plasma Hcy levels are closely correlated with the incidence of perioperative cardiovascular events and cardiovascular risk factors in diabetic patients undergo-ing non- cardiac surgery.