同型半胱氨酸水平与急性心肌梗死经皮冠脉介入治疗术中再灌注心律失常相关性研究

Homocysteine increases reperfusion arrhythmias during emergency percutaneous coronary intervention in patients of STEMI

目的探讨血同型半胱氨酸水平与急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术中再灌注心律失常的相关性。方法纳入158例急性心肌梗死行急诊PCI的患者,根据术中是否发生再灌注心律失常分为心律失常组78例和对照组80例,检测其血清肌酐、尿酸、总胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、空腹血糖及同型半胱氨酸水平,运用Pearson法分析各项指标与再灌注心律失常的相关性。结果心律失常组同型半胱氨酸水平高于对照组(P<0.01)。所有患者中,同型半胱氨酸水平与急诊PCI术中再灌注心律失常呈正相关(r=0.437,P<0.01)。ROC曲线下面积为0.751,95%可信区间为(0.676,0.826),计算Youden指数为0.39,根据Youden指数确定该研究资料中同型半胱氨酸预测再灌注心律失常最佳截点为12.4μmol·L-1(灵敏度72%,特异性67%)。结论同型半胱氨酸水平与急性心肌梗死PCI术中再灌注心律失常呈正相关,提示同型半胱氨酸水平是急性心肌梗死PCI术中再灌注心律失常的危险因素。当患者血同型半胱氨酸水平高于12.4μmol·L-1时,术中再灌注心律失常发生率明显增加。

Objective To analyze the correlation between serum homocysteine level and reperfusion arrhythmias during emergency percutaneous coronary intervention（PCI）. Methods 158 acute myocardial infarction patients who undergoing emergency PCI were divided into arrhythmia group with 78 cases and control group with 80 cases. The clinical data such as serum creatinine,uric acid,total cholesterol,low density lipoprotein cholesterol,high sensitive C reactive protein,fasting blood glucose and plasma homocysteine level were measured. The correlation of serum homocysteine level and reperfusion arrhythmia was analysed by pearson analysis. Results There was no significant difference between the two groups in clinical baseline data. The high sensitive C reactive protein,fasting blood glucose and homocysteine levels in the arrhythmia group were higher than those in the control group（P〈0. 01）. In all patients,homocysteine levels were positively correlated with reperfusion arrhythmias during emergency PCI（r = 0. 437,P〈0. 01）. The area under the ROC curve was 0. 751 and the 95% confidence interval was（0. 676,0. 826）. The best cut-off point of homocysteine levels for predicting the reperfusion arrhythmia was 12. 4 μmol·L-1（Se 72%,Sp 67%）. Conclusion Homocysteine levels are positively related to reperfusion arrhythmias during emergency PCI,suggesting that elevated homocysteine levels are risk factors for reperfusion arrhythmias. When the blood homocysteine level is higher than 12. 4 μmol·L-1,the incidence of intraoperative reperfusion arrhythmia is significantly increased.