非ST段抬高型急性冠脉综合征患者血清Hcy水平和GRACE评分与冠状动脉病变的相关性

Correlation of Hcy level and GRACE score with coronary artery stenosis in patients with non-ST segment elevation acute coronary syndrome

目的探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)患者血清同型半胱氨酸(Hcy)水平和全球急性冠状动脉事件注册(GRACE)评分与冠状动脉病变严重程度的关系。方法选取2015年1月至2016年1月就诊于湖南省人民医院符合纳入标准的NSTE-ACS患者116例,其中非ST段抬高型心肌梗死(NSTEMI)组49例,不稳定型心绞痛(UAP)组67例,入院后所有患者均进行GRACE评分,同时第2天清晨空腹采集肘静脉血检测Hcy,与48例非冠心病患者进行对照比较,分析Hcy水平与GRACE评分的关联性以及Hcy水平和GRACE评分与冠脉病变支数的关系。结果 1 NSTE-ACS患者血清Hcy水平、GRACE评分与非冠心病组比较差异有统计学意义,UAP组、NSTEMI组Hcy水平分别为(16.3±5.7)μmol/L和(19.6±4.6)μmol/L,明显高于非冠心病组的(11.3±2.7)μmol/L;UAP组、NSTEMI组GRACE评分分别为(108.9±21.0)分和(133.4±26.3)分,明显高于非冠心病组的(99.0±16.0)分,差异均具有统计学意义(P<0.05);2 NSTE-ACS患者血清Hcy水平随GRACE危险程度增加而显著升高,低危组、中危组、高危组Hcy水平分别为(12.7±3.1)μmol/L、(18.4±5.2)μmol/L、(22.4±5.1)μmol/L,差异具有统计学意义(P<0.05);相关性分析结果显示,NSTE-ACS患者血清Hcy水平与GRACE评分呈明显正相关(r=0.546,P<0.01);3 NSTE-ACS患者Hcy水平和GRACE评分与冠脉病变支数相关,三支血管病变组中Hcy水平、GRACE评分高于双支血管病变组,双支血管病变组高于单支血管病变组,差异均有统计学意义(P<0.05)。结论 NSTE-ACS患者Hcy水平与GRACE评分密切相关,结合Hcy水平测定与GRACE危险评分可提高对NSTE-ACS的预测,且一定程度上能反映冠状动脉病变程度,对NSTE-ACS早期介入治疗风险和预后评估有重要价值。

Objective To investigate the correlation of homocysteine（Hcy） levels and Global Registry of Acute Coronary Events（GRACE） score with the severity of coronary artery disease in patients with non-ST segment elevation acute coronary syndrome（NSTE-ACS）.Methods A total of 116 NSTE-ACS patients admitted to Hunan Provincial People＇s Hospital from January 2015 to January 2016 were divided into non-ST segment elevation myocardial infarction（NSTEMI） group（49 cases） and unstable angina pectoris（UAP） group（67 cases）.All patients were evaluated by GRACE score,and had the serum Hcy levels examined in the next morning after admission,which were compared with 48 controls without coronary artery disease（non-CAD group）.The correlations between Hcy levels and GRACE score were analyzed,and the relationship between Hcy levels,GRACE score and the number of diseased coronary branches were also analyzed.Results Serum Hcy level and GRACE score in NSTE-ACS patients were significantly higher than those in non-CAD group.The serum Hcy level in UAP group and NSTEMI group were（16.3±5.7） μmol/L,（19.6±4.6） μmol/L,which were significantly higher than（11.3±2.7） μmol/L in the non-CAD group.The GRACE scores in UAP group and NSTEMI group were（108.9±21.0）,（133.4±26.3）,which were significantly higher than（99.0±16.0） in the non-CAD group,with statistically significant differences（P〈0.05）.In patients with NSTE-ACS,the level of serum Hcy significantly increased with the increase of GRACE risk score.The Hcy levels in the low-risk group,medium-risk group,high-risk group were（12.7±3.1） μmol/L,（18.4±5.2） μmol/L,（22.4±5.1） μmol/L,respectively,with statistically significant difference（P〈0.05）.Correlation analysis showed that the serum Hcy level in NSTE-ACS patients had a positive correlation with GRACE scores（r=0.546,P〈0.01）.The serum Hcy level and GRACE score was correlated with the number of diseased coronary branches.The Hcy level and GRACE score were higher in NSTE-ACS patients with three diseased coronary branches than those with two branches,and in patients with two branches than single branch,with statistically significant difference（P〈0.05）.Conclusion Hcy level are closely related with GRACE score in NSTE-ACS patients.Combination of Hcy level and GRACE score could increase the prediction of NSTE-ACS,and reflect the degree of coronary artery disease,which has important value for the risk and prognosis evaluation of early intervention treatment.