血管内皮功能与同型半胱氨酸对老年冠心病病人病情的影响

Effect of vascular endothelial function and the serum level of Hcy on state of illness in elderly patients with coronary heart disease

目的研究血管内皮功能与同型半胱氨酸(Hcy)对老年冠心病病人病情的影响。方法选取2013年5月至2015年2月我院接收的老年冠心病病人658例,根据美国纽约心脏病协会(NYHA)的心功能分级标准,心功能Ⅰ级263例(A组),Ⅱ级231例(B组),Ⅲ~Ⅳ级164例(C组),另选179例身体健康状况良好的老年人作为对照组。检测并比较4组肱动脉血流介导的舒张功能(FMD)、颈动脉内膜中层厚度(IMTc)、同型半胱氨酸(Hcy)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标,并对血管内皮功能及Hcy水平与冠心病严重程度进行相关性分析。结果 A、B、C 3组反应性冲血后的血管内径变化(FMD%)明显低于对照组,Hcy水平和IMTc明显高于对照组,差异均有统计学意义(P<0.05);A、B、C 3组间FMD%、Hcy水平及IMTc比较,差异均有统计学意义(P均<0.05)。4组间HDL-C和LDL-C水平差异均无统计学意义(P>0.05)。有序Logistic回归分析结果显示,Hcy水平和FMD%均与冠心病严重程度有关,OR(95%CI)分别为1.654(1.246~1.857)和1.595(1.357~1.836)。结论老年冠心病病人血管内皮功能紊乱和Hcy水平升高可使其病症加重。

Objective To explore the effect of vascular endothelial function and the serum level of homocysteine（ Hcy） on coronary heart disease（ CHD） in elderly patients. Methods 658 elderly patients with CHD in our hospital were selected from May 2013 to February 2015,according to American New York Heart Association（ NYHA） classification of coronary heart disease criteria,and all CHD patients were divided into three groups,grade Ⅰ（ 263 cases group A）,grade Ⅱ（ 231 cases group B）,grade Ⅲ（ 164 cases group C）. 179 cases of healthy elderly people were selected as the control group.The brachial artery vascular flow-mediated diastolic function（ FMD）,carotid artery intima media thickness（ IMTc）,and the levels of homocysteine（ Hcy）,high density lipoprotein cholesterol（ HDLC）,low density lipoprotein cholesterol（ LDL-C） were detected and compared among four groups. The correlation of vascular endothelial function and Hcy level with CHD was analyzed by ordinal Logistic regression. Results The level of FMD% in group A,B,C was significantly lower,and the Hcy level and IMTc were significantly higher than those in control group（ all P〈 0. 05）. There were also significant difference in FMD%,Hcy level and IMTc among group A,group B and group C（ all P〈 0. 05）. Ordiral Logistrc regression analysis showed association between Hcy level and FMD with severity of CHD,OR（ 95%CI） was 1. 654（ 1. 246-1. 857） and 1. 595（ 1. 357-1. 836）,respectively. Conclusions The vascular endothelial dysfunction and the raised level of Hcy may aggravate illness in elderly patients with CHD.