同型半胱氨酸和颈动脉内膜中层厚度与老年冠心病严重程度的相关性

Association of serum homocysteine level and carotid IMT with coronary heart disease in elderly subjects

目的：探讨老年冠状动脉粥样硬化性心脏病（冠心病）患者血清同型半胱氨酸（Hcy ）、颈动脉内膜中层厚度（IM T ）与冠状动脉病变程度的关系。方法根据冠状动脉造影结果和临床表现，将227例老年患者分为冠心病组176例和对照组51例，再将冠心病组根据Gensini积分分为低分组104例（1～20分）、中分组43例（21～40分）及高分组29例（＞40分）。采用ELISA法测定各组血清Hcy水平，彩色多普勒超声诊断仪测定各组IM T ，比较各组Hcy、IM T是否存在差异。结果与对照组比较，冠心病组 Hcy和IM T增厚明显升高[（18．59±3．03）mmol／L vs （9．94±2．63）mmol／L ，（1．26±0．11）mm vs （0．81 ± 0．08）mm ，P＜0．05，P＜0．01]；与低分组比较，中分组和高分组Hcy、高Hcy血症、IMT增厚和IMT比例明显升高（P＜0．05）。多元logistic回归分析显示，Hcy和IMT增厚与冠心病严重程度呈独立正相关（OR＝10．89，95％ C I：1．43～70．80，P＝0．000；OR＝12．38，95％ C I：5．06～31．09， P＝0．000）。结论 Hcy和IM T与老年冠心病病变严重程度呈独立正相关关系，Hcy和IM T 能够间接反映老年冠心病患者冠状动脉病变的严重程度。

Objective To study the association of serum homocysteine （Hcy）level and carotid IMT with coronary heart disease （CHD） in elderly subjects .Methods Two hundred and twenty seven elderly CHD patients were divided into CHD group （n=176）and control group （n=51）according to their coronary arteriography .The patients in CHD group were further divided into 1 -20 Gensini score group （n=104） ,21-40 Gensini score group （n=43） and ＆gt;40 Gensini score group （n=29） .Their serum Hcy level and carotid IM T were measured by ELISA and colour Doppler ul‐trasonography ,respectively .Results The serum Hcy level was significantly higher and the carot‐id IMT was significantly greater in CHD group than in control group （18 .59 ± 3 .03 mmol/L vs 9.94±2.63mmol/L,P〈0.05 ;1.26±0.11mmvs0.81±0.08mm,P〈0.05,P〈0.01）.Theser‐um Hcy and HHcy levels were significantly higher and the IMT was significantly greater in 21-40 Gensini score group and ＆gt; 40 Gensini score group than in 1 -20 Gensini score group （ P〈0.05） .Multivariate logistic regression analysis showed that the serum Hcy level and IMT were positively associated with CHD （OR= 10 .89 ,95% CI：1 .43 -70 .80 ,P= 0 .000;OR= 12 .38 , 95% CI：5 .06-31.09 ,P=0 .000） .Conclusion The serum Hcy level and IM T are positively asso‐ciated with CHD ,and can indirectly mirror the severity of CHD in elderly subjects .