高同型半胱氨酸水平对冠心病严重程度及支架置入治疗预后的影响

Relationship between hyperhomocysteine and long-term outcome of coronary artery disease patients after drug-eluting stent implantation

目的探讨高同型半胱氨酸水平对冠心病患者冠状动脉病变严重程度及支架置入治疗远期预后的影响。方法采取前瞻性研究方法，连续入选2011年3月至2013年1月间在中大医院心内科首次接受冠脉内药物洗脱支架置入术治疗的冠心病患者1 408例。根据是否合并高同型半胱氨酸水平（H-Hcy）分为两组，合并H-Hcy组798例（Hcy≥10 μmol/L，占56.7%）、未合并H-Hcy组610例（Hcy〈10 μmol/L，占43.3%）。分析两组患者冠状动脉病变狭窄程度SYNTAX评分及支架置入术后随访1年主要心脑血管不良事件（MACCE）发生率的差异。并采用多因素Cox回归判断血清Hcy水平与支架置入患者MACCE的相关性。结果与不合并H-Hcy组患者比较，H-Hcy组患者冠状动脉病变狭窄程度更为严重，表现为冠状动脉病变支数更多（2.11±0.87比1.91±0.82，P〈0.001）、三支病变的比例更高[39.7%（317/798）比29.5%（180/610），P〈0.001]和SYNTAX评分更高（36.99±39.66比27.39±32.70，P＝0.001）。H-Hcy组患者随访1年累积MACCE发生率显著高于对照组患者（18.4%比8.9%，P〈0.001）。糖尿病（OR＝1.530，95%CI 1.142～2.050, P＝0.004）、年龄（OR＝1.065，95%CI 1.038～1.093，P〈0.001）及Hcy水平（OR＝1.019，95%CI 1.005～1.033, P＝0.009）是影响MACCE发生的独立预测因素。结论高Hcy水平与冠心病患者冠状动脉病变严重程度相关，且是冠心病患者支架置入术后发生MACCE的一个独立的预测因素。

ObjectiveTo explore the relationship between hyperhomocysteinemia （H-Hcy） and long-term outcome of coronary artery disease （CAD） patients after drug-eluting stent （DES） implantation in a single centre.MethodsA total of 1 408 consecutive patients implanted with DES in our department between March 2011 and January 2013 were enrolled in this prospective study. Patients were stratified into H-Hcy （Hcy≥10 μmol/L, n=798, 56.7%） and non-H-Hcy group （Hcy〈10 μmol/L, n=610, 43.3%）. The clinical characteristics, coronary artery lesions, SYNTAX score and 1-year major adverse cardiac and cerebrovascular events （MACCE） were compared between the two groups.ResultsCompared with non-H-Hcy group, coronary artery stenosis was severer as shown by higher diseased arteries （2.11±0.87 vs. 1.91±0.82, P〈0.001）, higher incidence of three diseased arteries （39.7% vs. 29.5%, P〈0.001） and higher SYNTAX score （36.99±29.66 vs. 27.39±22.70, P=0.001） in H-Hcy group. The 1-year incidence of MACCE was also higher in H-Hcy group compared with non-H-Hcy group（18.4% vs. 8.9%, P〈0.001）. Multivariate Cox analysis showed that diabetes mellitus （OR=1.530, 95%CI 1.142-2.050, P=0.004）, age （OR=1.065, 95%CI 1.038-1.093; P〈0.001）, and Hcy （OR=1.019, 95%CI 1.005-1.033, P=0.009） are the independent predictors for 1-year MACCE.ConclusionHigh Hcy level is correlated with the severity of coronary artery stenosis, and serves as an independent predictor of MACCE after stenting in CAD patients.