血清Hcy表达评估桥本氏甲状腺炎合并冠心病患者突发心绞痛的临床意义

Evaluation Significance of the Expression of Hcy in Serum of Patients with Hashimoto's Thyroiditis Complicated with Coronary Heart Disease to Sudden Angina

目的探讨血清Hcy表达评估桥本氏甲状腺炎合并冠心病患者突发心绞痛的临床意义。方法选取本院于2015年1月至2016年10月收治老年桥本氏甲状腺炎合并冠心病患者80例作为研究对象,根据是否突发心绞痛分为心绞痛组38例和非心绞痛组42例。测定和对比两组患者血清同型半胱氨酸(Hcy)、甲状旁腺激素(PTH)、促甲状腺激素(TSH)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)表达。冠状动脉造影测定和比较两组不同冠状动脉狭窄分级人数和冠状动脉狭窄率。相关性分析Hcy表达与各检测指标关系。结果心绞痛组患者Hcy、TC、LDL-C和TG表达显著高于非心绞痛组患者(P<0.05),而PTH、TSH和HDL-C表达显著低于非心绞痛组患者(P<0.05),心绞痛组冠状动脉狭窄C级患者人数显著高于非心绞痛组(x^2=3.872,P=0.037),冠状动脉狭窄率显著高于非心绞痛组(P<0.05),Hcy与TC、TG、LDL-C和冠状动脉狭窄率表达呈正相关(P<0.05),与HDL-C、PTH和TSH呈负相关(P<0.05)。以甲状腺炎合并冠心病患者是否突发心绞痛为因变量,将年龄、Hcy、TC、TG、HDL-C、LDL-C、PTH、TSH、CAS为自变量,引入多因素Logistic回归模型,结果显示,Hcy、TC、TG、HDL-C、LDL-C、TSH、CAS均是突发心绞痛的危险因素(P<0.05),选择多因素Logistic回归模型分析中OR值>1的因素做ROC曲线分析,ROC曲线面积(AUC)表现为Hcy>TC>TG>LDL-C>CAS>HDL-C>TSH,Hcy诊断的敏感性低于CAS、TG、TC、HDL-C,而特异性则最高,临界值在25.57。结论高表达Hey是HT合并冠心病患者突发心绞痛的高风险因素,应对此类患者及时采取相应治疗手段。

Objective To investigate the clinical significance of evaluation of serum Hcy level to assess of Hashimoto＇s thyroiditis patients with coronary heart disease and sudden angina. Methods 80 case of old Hashimoto＇s thyroiditis patients with coronary heart disease were selected as the research objects in our hospital from January 2015 to October 2016. According to having the sudden angina or not, these cases were divided into 38 cases of angina pectoris and 42 cases of angina pectoris. Determination and comparison of two groups of patients with serum homocysteine （ Hcy ） , parathyroid hormone （ PTH ） , thyroid stimulating hormone （TSH）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, triglyceride （TG） expression three were performed. The number of coronary artery stenosis and coronary artery stenosis were measured and compared between the two groups. Correlation analysis of the relationship between Hcy expression and detection indexes was used. Results The expression levels of Hcy TC, LDL-C and TG in angina group were significantly higher than that those in angina pectoris （ P 〈 0.05 ） and the expression levels of PTH, TSH and HDL- C were significantly lower than that in patients with angina pectoris （P 〈 0.05 ）. Angina pectoris of coronary artery stenosis in patients with grade C were significantly higher than that of non angina group （χ2 = 3. 872, P =0. 037 ）, and coronary artery stenosis rate was significantly higher than that of non angina group （P 〈 0.05 ）. Hcy and TC, TG, LDL-C and coronary artery stenosis rate were positively correlated with expression （ P 〈 0. 05 ）, and negatively correlated with HDL- C, PTH and TSH （ P 〈 0.05 ）. With thyroiditis in patients with coronary heart disease, angina pectoris was unexpected as the dependent variable, age, Hcy, TC, TG, HDL-C, LDL-C, PTH, TSH and CAS as independent variables. And the introduction of multi factor Logistic regression model showed that Hcy, TC, TG, HDL-C, LDL-C, TSH, CAS were risk factors to sudden angina pectoris （P 〈 0.05 ）, a multi factor Logistic regression model analysis or value factors of 〉 1 ROC curve. ROC curve area （AUC） was Hcy 〉 TC 〉 TG 〉 LDL- C 〉 CAS 〉 HDL- C 〉 TSH, while the diagnostic sensitivity of Hcy was lower than CAS, TG, TC, HDL-C, and specificity of the most high, the critical value in 25.57. ConcLusion High expression of Hcy is a high risk factor for patients with coronary heart disease complicated with coronary heart disease （CHD） in HT patients.