同型半胱氨酸、D-D二聚体与冠状动脉病变程度的临床分析

Clinical analysis of correlation of homocysteine and D-Dimer level with coronary lesion severity

目的探讨血同型半胱氨酸、D-D二聚体与冠状动脉病变程度相互关系。方法回顾性分析2012年1月～2014年1月，在海军总医院住院行冠状动脉造影检查者315例。根据造影结果，分为对照组（n=112）和冠心病组CHD（n=203），根据SYNTAX评分，将冠心病分低危组（1～22分）、中危组（23～32分）和高危组（〉33分）。测定血同型半胱氨酸、血尿酸、D-D二聚体、C反应蛋白及空腹血脂：TC、TG、HDL-C、LDL-C、BMI、载脂蛋白A和载脂蛋白B，并且比较各组患者上述检测的指标。结果冠心病CHD组血同型半胱氨酸（6．86±2．63VS，15．97±9．23umol／l，P〈0．011、D—D二聚体（104．01±49．9VS，329．03±394．24，P〈0．01）、高密度脂蛋8（1．79±1．31VS，1．26±0．55，P〈O．01）、血尿酸（244．82±110．83vs，301．95±72．25umol／L，P〈0．05）、C反应蛋白（2．12±1．31vs，6．39±5．42，P〈0．01）值显著高于对照组。TC、TG、LDL—C、载脂蛋白A和载脂蛋白B两者无明显差别。SYNTAX评分高危组、中危组、低危组与对照组比较血同型半胱氨酸、血尿酸、D—D二聚体、c反应蛋白、高密度脂蛋白显著增高，差异有统计学意义，P〈0．05；SYNTAX评分高危组、中危组、低危组与对照组比较TC、TG、LDL—C、BMI、载脂蛋白A和载脂蛋白B无明显差异，P〉0．05。多元LogistiC回归分析表明血同型半胱氨酸、D—D二聚体与冠状动脉病变程度相关。结论血同型半胱氨酸、D—D二聚体是冠状动脉病变严重程度的相关危险因素，随着血同型半胱氨酸、D—D二聚体水平的增高，冠状动脉病变程度增加。

Objective To evaluate correlation between homocysteine and D-Dimer level and coronary lesion severity in coronary artery disease （CAD） patients. Methods A retrospective analysis was performed on a total of 315 patients who were admitted and received coronary angiography inspection in between January 2012 and January 2014. The patients were divided into the control group （n=112） and the coronary heart disease （CHD） group （n=203） based on the results of coronary angiography. According to SYNTAX score, CHD patients were divided into three groups, low-risk group with score of 1~22 score, middle-risk group with score of 23±32, and high risk group with score 〉 33. Homocysteine, blood uric acid, D-Dimer, c-reactive protein and fasting blood lipids including total cholesterol （TC）, triglycerides （TG）, high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C）, BMI, apolipoprotein A and apolipoprotein B were detected. The indexes were compared between groups. Results Blood homocysteine （6.86±2.63 vs, 15.97±9.23 umolfl, P 〈0.01）, D-Dimer （104.01 ±49.9 vs,329.03±394.24,P 〈0.01）, high density lipoprotein （1.79± 1.31 vs, 1.26±0.55, P 〈0.01）, blood uric acid （244.82± 110.83 vs,301.95±72.25 umol/L,P 〈0.05）, c-reactive protein （2.12± 1.3! vs, 6.39 ± 5.42,P 〈0.01） value is significantly higher in CHD group than in the control group. No significant difference was found in TC, TG, LDL- C, apolipoprotein A and apolipoprotein between groups. Comparing with the control group, the index reflected higher on blood homocysteine, blood uric acid, D-Dimer, c-reactive