血清同型半胱氨酸水平与老年急性肺栓塞患者早期死亡的相关性

Association between the lever of homocysteine and in-hospital death in elderly patients with acute pulmonary embolism

目的探讨血清同型半胱氨酸（homocysteine,Hcy）水平与老年急性肺栓塞患者早期死亡的相关性。方法 210例老年急性肺栓塞患者,根据血清Hcy水平分为高Hcy组（Hcy≥16.3μmol/L）102例和低Hcy组（Hcy〈16.3μmol/L）108例,记录患者病史、实验室检查及辅助检查结果、肺栓塞相关的早期死亡事件,并进行为期1a随访,采用Cox比例危险模型分析血清Hcy水平与急性肺栓塞患者早期死亡的相关性。结果患者住院时间1~38（9±7）d,高Hcy组死亡13例,低Hcy组死亡5例,高Hcy组早期病死率（12.7%）高于低Hcy组（4.6%）（P〈0.05）;高Hcy组心率[（118±19）次/min]、Hcy[（18.7±2.3）μmol/L]、肌酐[（14.8±8.7）mg/L]、氧饱和度[（82.5±1.5）%]、肌钙蛋白T峰值[（9.9±1.2）μg/L]、深静脉血栓史比率（44.1%）与低Hcy组[（103±14）次/min,（8.1±0.9）μmol/L,（10.0±4.3）mg/L,（92.3±8.5）%,（7.4±1.1）μg/L,25.9%]比较差异有统计学意义（P〈0.05）;Cox比例危险模型分析显示,校正性别后,心率（HR=1.012,95%CI：1.010~1.062,P=0.002）、高Hcy值（HR=4.130,95%CI：3.500~4.982,P=0.003）、深静脉血栓（HR=1.782,95%CI：1.592~1.821,P=0.008）是急性肺栓塞患者早期死亡的独立预测因子;随访1a,高Hcy组肺栓塞相关死亡与次要终点发生率（2.3%、14.6%）与低Hcy组（0.9%、6.7%）比较差异无统计学意义（P〉0.05）。结论血清Hcy水平与老年急性肺栓塞患者早期死亡相关。

Objective To investigate the association between serum homocysteine（Hcy）and in-hospital death in elderly patients with acute pulmonary embolism（APE）.Methods A total of 210 elderly patients with APE were divided into high-Hcy group（Hcy≥16.3μmol/L,n=102）and low-Hcy group（Hcy16.3μmol/L,n=108）.The disease history,laboratory results,auxiliary examination results and the incidence of APE-related death in the early stage were recorded,and patients were followed up for 1year.The Cox proportional hazard model was used for analyzing the association between serum Hcy and in-hospital death.Results The average hospitalization stay was from 1to 38（9±7）days.HighHcy group had a higher in-hospital fatality（13patients,12.7%）than low-Hcy group（5patients,4.6%）（P0.05）.The heart rate（HR）（（118±19）beats/min）,Hcy level（（18.7±2.3）μmol/L）,serum creatinine（SCr）level（（14.8±8.7）mg/L）,oxygen saturation（SO2）（（82.5±1.5）%）,troponin T（TnT）（（9.9±1.2）μg/L）and deep venous thrombosis（DVT）rate（44.1%）in high-Hcy group were significantly different from those in low-Hcy group（HR：（103±14）beats/min,Hcy：（8.1±0.9）μmol/L,SCr：（10.0±4.3）mg/L,SO2：（92.3±8.5）%,TnT：（7.4±1.1）μg/L,DVT rate：25.9%）（P0.05）.Multivariate Coxregression analysis indicated that HR（HR=1.012,95%CI：1.010 to 1.062,P=0.002）,high-Hcy level（HR=4.130,95%CI：3.500 to 4.982,P=0.003）and DVT（HR=1.782,95%CI：1.592 to 1.821,P=0.008）were independent predictors for in-hosiptal death in patients with APE.One-year follow-up survey showed the incidences of APE-related death and second end points were 2.3% and 14.6%in high-Hcy group,showing no significant differences in comparison with low-Hcy group（0.9%,6.7%）（P0.05）.Conclusion Serum Hcy level is correlated with in-hospital death in the elerly patients with APE.