血浆同型半胱氨酸与急性心肌梗死患者预后的相关性研究

Study on correlation between plasma homocysteine level and prognosis in patients with acute myocardial infarction

目的探讨血浆同型半胱氨酸(Hcy)水平与急性心肌梗死(AMI)患者远期发生主要心血管不良事件(MACE)的相关性。方法连续纳入2012年3月至2014年12月该院心血管内科住院治疗的AMI患者共326例,Hcy等实验室生化指标均由医院医学检验科按标准流程进行检测。对Hcy水平与MACE发生率进行ROC曲线分析,按Cut-off值11.69μmol/L将研究对象分为Hcy(L)组及Hcy(H)组,收集研究对象的临床基线资料,并定期随访,记录MACE。结果 Hcy(L)组血浆N端B型脑钠钛前体(NT-pro BNP)水平明显低于Hcy(H)组[(501.46±118.35)pg/mL vs.(1 324.11±523.13)pg/mL,P=0.02],而左心室射血分数(LVEF)则明显高于Hcy(H)组[(55.23±9.48)%vs.(50.79±10.68)%,P=0.03]。随访1年后Hcy(H)组LVEF与基线相比明显降低[(45.32±10.18)%vs.(50.79±10.68)%,P<0.05],且Hcy(H)组MACE发生风险明显高于Hcy(L)组,校正相关混杂因素后仍差异有统计学意义(P=0.048),而Hcy(L)组LVEF、左心室短轴缩短率(FS)与基线资料相比无明显差异[(54.43±10.68)%vs.(55.23±9.48)%、(28.56±6.21)%vs.(29.22±5.30)%,P>0.05]。结论 AMI合并高血浆Hcy水平患者发生远期MACE风险较低血浆Hcy水平者明显增加,预后较差,提示血浆高Hcy水平是AMI患者预后不良可能的独立预测因子之一,但其在AMI发生、发展中的作用机制及Hcy干预治疗能否改善AMI患者预后仍有待进一步研究。

Objective To investigate the correlation between plasma homocysteine（Hcy） and long term occurrence of main adverse cardiac events（MACE） in the patients with acute myocardial infarction（AMI）. Methods A total of 326 inpatients with AMI in the cardiology department of this hospital from Mar. 2012 to Dec. 2014 were continuously included. The related laboratory biochemical indicators such as Hey were detected according to the standard flow process by the hospital clinical laboratory depart- ment. The Hey level and MACE occurrence rate were performed the receiver operating characteristic（ROC） curve analysis. The re- search subjects were divided into the Hey（L） group and Hey（H） group according to the cut-off value 11.69 μmol/L. The base line data of all subjects were collected and the follow up was conducted for recording MACE. Results The plasma N-terminal pro-brain natriuretic peptide （NT-ProBNP） level in the Hey（L） group was significantly lower than that in the Hey（H） group[（501.46 ± 118.35）pg/mL vs. （1 324.11± 523. 13）pg/mL, P= 0. 02], while the left ventricular ejection fraction（LVEF） was significantly higher than that in the Hey（H） group[（55.23± 9.48）% vs. （50.79±10.68）%, P= 0.03]. After 1-year follow up, LVEF in the Hcy（H） group was significantly decreased compared with the base line [（45.32 ± 10.18）% vs. （50.79±10.68）, P〈0.05], mo- reover the MACE occurrence risk in the Hey（H） group was significantly higher than that in the Hey（L） group,the difference after correcting the related confounding factors had statistical significance （P= 0. 048） ,but LVEF and minor axis shortening rate of left ventriele（FS） in the Hey（L） group had no obvious difference compared with the base line data[ （54.43±10.68）% vs. （55. 23±9.48）%, （28.56＋- 6.21）% vs. （29.22± 5.30） % ,P〉0.05]. Conclusion The risk of long term MACE occurrence in the patients with AMI complicating plasma high Hcy level is obviously increased compared with that in the patients with plasma low Hcy level and the prognosis is poor, prompting that plasma high Hcy level is one of possible independent predicting factors for poor prognosis in thepatients with AMI. But its action mechanism and whether the Hcy interventional therapy improving prognosis of AMI pa- tients still need to further study.