同型半胱氨酸与冠心病的相关性及其机制探讨

The correlation between plasma homocysteine and coronary heart disease and the study on its pathogenesis

目的 探讨血浆同型半胱氨酸 (HCY)与冠心病 (CHD)的相关性、与CHD传统危险因素的关系及其致CHD的机制。方法 分别测定CHD患者 (10 5例 )及对照组 (32例 )血中HCY、内皮素(ET)、一氧化氮 (NO)、一氧化氮合酶 (NOS)水平及血脂各参数。结果 CHD组高同型半胱氨酸血症(HHCY)的发生率明显高于对照组 (49 5 %比 9 4 % ,P <0 0 1) ,CHD组HCY水平明显高于对照组[(15 2 9± 5 14 ) μmol L比 (10 6 6± 2 78) μmol L ,P <0 0 1]。多元回归分析显示HCY对CHD的相对危险度 (RR)为 1 397(95 %可信区间 :1 137～ 1 6 4 5 ,P <0 0 1) ,表明HCY为CHD的独立危险因素。HCY与年龄、甘油三酯有关 (P <0 0 5 )。HCY与ET呈正相关 (P <0 0 1) ,而与NO、NOS呈负相关 (P <0 0 1)。结论 HHCY是CHD的独立危险因素。HCY可能损伤血管内皮细胞 ,使血管内皮功能失调。

Objective To investigate the correlation between plasma homocysteine (HCY) and coronary heart disease(CHD), to estimate the relationships between HCY and some established cardiovascular risk factors, and to probe its probable pathogenesis which HCY results in CHD Methods The fasting plasma total levels of HCY, endothelin(ET),serum nitric oxide(NO), nitric oxide synthetase(NOS), triglyceride(TG),total cholesterol(TC), high density lipoprotein cholesterol (HDL C) and low density lipoprotein cholesterol (LDL C) of 105 cases with documented CHD and 32 age and gender matched controls were detected respectively Prior medical histories including essential hypertension(EH)?diabetes mellitus(DM), related family history(FH) and smoking status were obtained from allparticipants via a questionnaire Results There was a significantly higher incidence of hyperhomocysteinemia(HHCY) in case group than those in control group(49 5% vs 9 4%, P <0 01) HCY concentrations were also obviously higher in case group than those in control group(15 29±5 14μmol/L vs 10 66± 2 78μmol/L, P <0 01) Based on multiple stepwise logistic regression analysis, the relative ratio ( RR ) of HCY to CHD was 1 397(95%CI: 1 137 1 645, P <0 01) It indicated that HCY was a significant and independent risk factor for CHD Multiple linear regression analysis showed that HCY had significant correlations with age and TG( P <0 05), while sex, EH, DM, FH, smoking, TC, HDL C and LDL C had no obvious influence on HCY Plasma ET levels were significantly higher in CHD subjects than in controls ( P <0 01), whereas serum NO and NOS levels were noticeably lower in CHD subjects than in controls ( P <0 01) NO levels were inversely related to ET levels and positively related to NOS levels significantly ( P <0 01) HCY levels had positive relations with ET, whereas negative relations with NO and NOS ( P <0 01) Conclusion Plasma HCY levels are relative with CHD HHCY is an independent risk factor for CHD Not only can it predict the occurrence of cardiovascular events, but also it is a predictor for the development of CHD The probable pathogenesis by which HCY involves in CHD is suggested that HHCY leads to the injury and dysfunction of vessel endothelial