冠状动脉粥样硬化性心脏病患者Hcy、hs-CPR及cIMT检测的临床意义

Study on clinical significance of Hcy,hs- CPR and cI MT detection in patients with coronary heart disease

目的探讨血清同型半胱氨酸(Hcy)、高敏C-反应蛋白(hs-CRP)及颈动脉内中膜厚度(c IMT)检测在冠状动脉粥样硬化性心脏病(CHD)诊治中的价值。方法比较86例CHD患者(CHD组)和50例健康体检者(对照组)血清Hcy、hs-CRP水平和c IMT,比较CHD组稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、急性心肌梗死(AMI)患者之间上述三项指标,并比较CHD组单支、双支、三支血管病变组上述三项指标,分析CHD组血清Hcy、hs-CRP水平和c IMT的相关性。结果血清Hcy、hs-CRP水平及c IMT CHD组均高于对照组,血清Hcy、hs-CRP水平及c IMT在SAP组[(11.09±3.88)μmol/L,(17.31±4.02)μmol/L,(21.15±4.68)μmol/L]、UAP组[(6.46±3.16)mg/L,(12.58±3.82)mg/L,(17.19±4.03)mg/L]、AMI组[(1.26±0.38)mm,(1.34±0.41)mm。(1.61±0.44)mm]及单支[(12.47±3.68)μmol/L,(16.26±4.31)μmol/L,(20.08±4.72)μmol/L]、双支[(7.14±3.20)mg/L,(13.09±3.77)mg/L,(17.02±4.11)mg/L]、三支血管病变组[(1.31±0.33)mm,(1.47±0.39)mm,(1.57±0.43)mm]呈增加趋势(P<0.05);血清Hcy、hs-CRP水平组间两两比较差异有统计学意义(P<0.05),c IMT AMI组高于UAP组和SAP组(P<0.05);c IMT与血清Hcy、hs-CRP水平呈正相关(r=0.468、0.516,P<0.05),血清Hcy水平与hs-CRP水平呈正相关(r=0.829,P<0.05)。结论血清Hcy、hs-CRP水平和c IMT与CHD的发生、发展密切相关,三项指标检测对于CHD的诊断、病情判断具有重要意义。

Objective To explore the diagnostic and therapeutic significance of serum levels of homocysteine（ Hcy） and hypersensitive C- reactive protein（ hs- CRP） and carotid artery intima- media thickness（ c IMT） in patients with coronary heart disease（ CHD）. Methods Serum levels of Hcy and hs- CRP and c IMT in 86 patients with CHD（ CHD group） were compared with those of 50 healthy controls（ control group）,and these indexes were compared among patients with stable angina pectoris（ SAP）,unstable angina pectoris（ UAP） and acute myocardial infarction（ AMI） in CHD group,and above mentioned three indexes were compared among patients with single,double and three vessels impaired in patients of CHD group,and the correlation among serum levels of Hcy and hs- CRP and c IMT had been studied in patients of CHD group. Results The serum levels of Hcy and hs- CRP and c IMT of patients in CHD group were higher than those of controls in control group.The serum levels of Hcy and hs- CRP and c IMT were [（ 11. 09 ± 3. 88） mol / L,（ 17. 31 ± 4. 02） mol / L,（ 21. 15 ± 4. 68） mol / L] respectively in SAP group,[（ 6. 46 ± 3. 16） mg / L,（ 12. 58 ± 3. 82） mg / L,（ 17. 19 ± 4. 03） mg / L]respectively in UAP group,[（ 1. 26 ± 0. 38） mm,（ 1.34 ± 0. 41） mm.（ 1. 61 ± 0. 44） mm] respectively in AMI group,and [（ 12. 47 ± 3. 68） mol / L,（ 16. 26 ± 4. 31） mol / L,（ 20. 08 ± 4. 72）mol / L]respectively in single vessel lesion group,[（ 7. 14 ± 3. 20） mg / L,（ 13. 09 ± 3. 77） mg / L,（ 17. 02 ± 4. 11） mg / L]respectively in double vessels lesion group,and [（ 1. 31 ± 0. 33） mm,（ 1. 47 ± 0. 39） mm,（ 1. 57 ± 0. 43） mm] respectively in three vessels lesion group,and they showed an increase tendency（ P〈0. 05）. There was statistically significant difference in serum levels of Hcy and hs- CRP between these two groups（ P〈0. 05）. The c IMT in patients of AMI group was higher than that of patients in UAP group and SAP group（ P〈0. 05）. The c IMT was positively correlated with serum levels of Hcy and hs- CRP（ r = 0. 468,0. 516,P〈0. 05）. Serum level of Hcy was positively correlated with level of hs- CRP（ r = 0. 829,P〈0. 05）. Conclusion Serum levels of Hcy and hs- CRP and c IMT are closely correlated with the occurrence and development of CHD,these three indicators have important significance in diagnosis and judgment of the prognosis of patients with CHD.