急性冠状动脉综合征患者血浆同型半胱氨酸水平与左心室射血分数及心功能严重程度的相关性研究

The relationship between homocysteine and left ventricular ejection fraction,severity of heart failure in acute coronary heart syndrome patients

目的探讨急性冠状动脉综合征(ACS)患者血浆同型半胱氨酸(Hcy)水平与左心室收缩功能及临床心功能的相关性。方法纳入2005年至2013年就诊北京大学第一医院接受冠状动脉造影(CAG)的ACS患者548例,其中男394例,平均年龄(61.2±12.3)岁。检测患者入院时血浆Hcy、叶酸水平,行CAG收集冠状动脉病变数据,评估入院临床心功能,行超声心动图检查采集左心室射血分数(LVEF)指标,分析心脏收缩功能及临床心功能与血浆Hcy的相关性。结果多元线性回归分析显示,在校正混杂因素后,血浆Hcy与LVEF独立相关(β=-0.237,95%CI-0.375^-0.041,P=0.015);随着心功能分级的增加,血浆Hcy水平逐渐增加,NYHA/Killip分级Ⅲ/Ⅳ级Hcy显著高于Ⅱ级和Ⅰ级(P=0.046和P=0.021);亚组分析显示在女性组、非糖尿病组、正常肾功能组、非高血压组、非陈旧心肌梗死组及急性心肌梗死组中NYHA/Killip分级Ⅲ/Ⅳ级心力衰竭患者Hcy水平高于正常心功能患者,差异均有统计学意义(P<0.05);女性组在校正其他混杂因素后,Hcy是临床心力衰竭的独立危险因素(OR=1.188,P=0.006)。在全体人群及急性心肌梗死、不稳定型心绞痛、女性亚组中,随Hcy水平升高,中重度心力衰竭风险增加(OR分别为1.081、1.102、1.152、1.191,P<0.05)。结论 ACS患者血浆Hcy水平与LVEF负相关、与临床心功能严重程度相关;Hcy是女性ACS患者临床心力衰竭的危险因素;在全体人群及急性心肌梗死、不稳定型心绞痛、女性亚组中,随血浆Hcy水平升高中重度心力衰竭风险增加。

Objective The aim of our study was to assess the plasma level of homocysteine （Hcy） and its relationship with left ventricular ejection fraction and the severity of heart failure in patients with acute coronary syndrome （ACS） . Methods We studied 548 patients with ACS [ （61.2 ± 12. 3） years old, 394 men and 154 women] . We measured plasma Hcy and folic acid, evaluated clinical evidence of heart failure and by echocardiograpbic criteria for left ventrieular systolic dysfunction. We also collected other clinical data and coronary angiographic data. Results The line regression model showed that Hcy was negatively associated with LVEF （β = -0. 237, 95% CI -0. 375 - -0. 041, P =0. 015）, even after adjusting for other risk factors. Homocysteine levels have proved to become higher with NYHA/Killip class m/IV progression comparing with class Ⅱ and I （P =0. 046 and 0. 021 respectly） . And the correlation between homocysteine plasma levels and the severity of heart failure in patients was seen in women, non diabetic, normal renal function, AMI and without prior myocardial infarction groups. In women, Hcy was independently associated with heart failure （ OR = 1. 188, P = 0. 006 ） . In total patients and in acute myocardial infarction, unstable angina, women subgroups, Hcy was associated with higher risk for moderate/severe heart failure （OR = 1.081, 1.102, 1.152, 1.191, respectively, P 〈 0.05） . Conclusions Increased plasma homocysteine levels negatively correlated with left ventricular ejaction fraction in ACS patients. There was a statistically significant correlation between homocysteine plasma levels and the severity of heart failure. In women, Hcy was a risk factor for heart failure. In total patients and in acute myocardial infarction, unstable angina, women subgroups, Hcy was a risk factor for moderate/severe heart failure.