脉压指数联合同型半胱氨酸对冠脉严重程度的评估价值

Value for assessing coronary artery severity by pulse pressure index combined with homocysteine

目的：探讨脉压指数（PPI）联合血清同型半胱氨酸（Hcy）对预测冠心病（CHD）发病危险及严重程度的价值。方法收集2012年4月-2014年12月徐州医学院附属医院心内科住院的高血压且行冠状动脉造影（CAG）患者320例,根据CAG结果将患者分为正常组（n=95）与CHD组（n=225）,分别计算其脉压（PP）及PPI,同时测量Hcy及相关临床生化指标。根据PPI及Hcy水平将CHD组患者分为6组,A组：Hcy〈15μmol/L且PPI〈0.4组（n =77）；B组：Hcy≥15μmol/L且PPI〈0.4组（n =26）；C组：Hcy〈15μmol/L且0.4≤PPI〈0.5组（n =109）；D组：Hcy≥15μmol/L且0.4≤PPI〈0.5组（n =27）；E组：Hcy〈15μmol/L且PPI≥0.5组（n =31）；F组：Hcy≥15μmol/L且PPI≥0.5组（n=50）。了解Hcy水平与CHD患病率及严重程度（Gensini积分）的关系,并行Gensini积分与PPI、Hcy的相关分析。结果随着PPI和血Hcy水平增加,CHD的患病率及Gensini积分亦逐渐增高（P〈0.05）。 PPI与血Hcy联合分组,PPI与血 Hcy均增高组 CHD患病率及 Gensini积分显著增加（P 〈0.01）,以 Hcy≥15μmol/L且PPI≥0.5组为甚。 Gensini积分与PPI、Hcy呈正相关（r 越0.629、0.616,均P〈0.01）。结论对于EH患者CHD发生及严重程度,应用PPI联合血Hcy比单纯应用PPI或单纯血Hcy有更好的预测价值。

Objective To explore the prevalence rate of coronary heart disease （CHD） and the severity of the coronary artery disease by the pulse pressure index （PPI） combined with homocysteine （Hcy）. Methods From April 2012 to De-cember 2014, 320 patients with essential hypertension （EH） hospitalized in Affiliated Hospital of Xuzhou Medical Col-lege and were given the detection of coronary arteriography （CAG） were selected, and they were divided into the CHD group （n = 95） and normal group （n = 225） according to the result of coronary arteriography. Pulse pressure （PP） and PPI were calculated respectively, and Hcy and clinical biochemical indicators were measured. To understand the rela-tionship of each group with the prevalence rate of CHD and the severity of the coronary artery, six different combined groups were divided according to the results of PPI： group AHcy〈15 μmol/L and PPI〈0.4 group （n = 77）, group B：Hcy≥15μmol/L and PPI〈0.4 group （n =26）, group C： Hcy〈15μmol/L and 0.4≤PPI〈0.5 group （n =109）, group D：Hcy≥15μmol/L and 0.4≤PPI〈0.5 group （n=27）, group E：Hcy〈15μmol/L and PPI≥0.5 group （n=31）, group F：Hcy≥15μmol/L and PPI≥0.5 group （n= 50）. The prevalence rate of CHD and the severity of coronary artery （Gensi-ni score） in different levels of Hcy were assessed. Meanwhile, correlation of Gensini score and PPI, Hcy was analyzed. Results With the increasing of PPI and the level of Hcy, the prevalence rate of CHD and Gensini scores had been in-creased gradually. In PPI and Hcy combined groups, with the level of PPI and Hcy increasement, the prevalence rate of CHD and the Gensini scores were increased significantly, reached the peak especially in Hcy≥15 μmol/L with PPI≥0.5 group （P〈 0.01）. Correlation analysis showed that, Gensini scores were positively correlated with PPI, Hcy （r =0.629, 0.616, all P〈 0.01）. Conclusion The better predictive value for the prevalence rate of CHD and the severity of coronary artery disease in patients with EH had been shown by application of PPI combined with the level of Hcy compared with the single application of PPI or Hcy.