老年冠心病患者同型半胱氨酸、尿酸与冠状动脉狭窄及左心功能的相关性探讨

A preliminary study on the relationship between homocysteine and uric acid with coronary artery stenosis and left ventricular function in elderly patients with coronary heart disease

目的探讨老年冠心病患者同型半胱氨酸(HCY)、尿酸(UA)与冠状动脉狭窄及左心室功能的相关性。方法根据同型半胱氨酸及血尿酸水平将143例老年冠心病患者分为高UA+正常HCY组、正常UA+高HCY组和高UA+高HCY组,另外选取同期收治的老年冠心病且HCY和UA正常的患者57例作为对照组。分别采用免疫荧光偏振法和氧化酶法测定血清HCY和UA的水平,根据冠状动脉造影结果,通过Gensini评分系统对冠状动脉血管病变程度进行定量评分,得出Gensini积分。采用心脏超声检查测定左心房舒张末期内径(LAD)、左心室舒张末期内径(LVDd)、左心室收缩末内径(LVDs)和左心室射血分数(LVEF)。结果与对照组比较,高UA+正常HCY组、正常UA+高HCY组和高UA+高HCY组的Gensini评分、LAD、LVDd和LVDs显著升高,LVEF显著降低,差异有统计学意义(P<0.05)。与高UA+高HCY组比较,高UA+正常HCY组、正常UA+高HCY组的Gensini评分、LAD、LVDd和LVDs显著降低,LVEF显著升高,差异有统计学意义(P<0.05)。结论高HCY和高UA对老年冠心病患者的冠状动脉狭窄和左心功能降低有促进作用,且两者之间有协同作用。

Objective To explore the relationship between homocysteine and uric acid with coronary artery stenosis and left ventricular function in elderly patients with coronary heart disease.Methods A total of 143 elder patients with coronary heart disease were divided into high Hcy and normal UA group,high UA and normal Hcy group and high Hcy plus high UA group,besides,57 elder patients with coronary heart disease and normal level of Hcy and UA were selected as control group.Serum levels of homocysteine and uric acid in all patients were measured with chemiluminescence immunity and oxidase method respectively.Echocardiography was performed to assess left ventricular function.Results The Gensini scores,left atrial end-diastolic diameter（ LAD）,left ventricular end-diastolic diameter（ LVDd） and left ventricular end-systolic inner diameter（ LVDs） in high Hcy and normal UA group,high UA and normal Hcy group and high Hcy and high UA group were significantly higher than those in group D（ P〈0.05）.The figures of left ventricular ejection fraction（ LVEF） in high Hcy and normal UA group,high UA and normal Hcy group and high Hcy and high UA group were significantly lower than those in group D（ P〈0.05）.The figures of Gensini,LAD,LVDd and LVDs in high Hcy and high UA group were significantly higher than those in high UA and normal Hcy group and high Hcy and normal UA group（ P〈0.05）.The figures of LVEF in high Hcy and high UA group were significantly lower than those in high UA and normal Hcy group and high Hcy and normal UA group（ P〈0.05）.Left ventricular end-diastolic diameter（ LAD）,left ventricular end-diastolic diameter（ LVDd）,left ventricular systolic diameter（ LVDs） and left ventricular ejection fraction（ LVEF） were determined by cardiac ultrasound.Conclusion The levels of UA and Hcy in elderly patients with coronary heart disease have a promoting effect on the decrease of coronary artery stenosis and left ventricular function,and there is a synergistic effect between Hcy and UA.