同型半胱氨酸水平在急性心肌梗死患者伴充血性心力衰竭中的临床价值

Clinical significance of homocysteine level to patients with acute myocardial infarction complicating congestive heart failure

目的 探讨急性心肌梗死患者血清同型半胱氨酸水平变化情况，分析其与心力衰竭发生的关系。方法 选取2012年10月～2013年10月期间在石家庄市第一医院CCU病房住院的急性心肌梗死患者100例，其中男性84例，女性16例，年龄49～84（63.6±3.4）岁。将患者分为两组：高同型半胱氨酸组（Hcy＞10.8 μmol/L，H组，n=49）；对照组（Hcy＜10.8 μmol/L，C组，n=51）。检测患者入院时Hcy、脑钠肽（BNP）、左室射血分数（LVEF）水平，以及肌酸激酶（CK）、肌钙蛋白T（TnT）峰值等。记录入院后心力衰竭发生情况。结果 H组的HCY水平明显高于C组[（17.4±1.4）μmol/L vs. （8.2±0.3）μmol/L]，差异有统计学意义（P＜0.01）。采用Kaplan-Meier曲线对两组患者的心力衰竭发病率进行比较，H组的发病率明显高于C组（43.7% vs. 12.5%，P＜0.001）。入院时心功能分级为KillipⅠ级（没有心力衰竭的相关症状）的患者81例，H1组38例，C1组43例。结果显示，H1组患者的血清同型半胱氨酸水平显著高于C1组 [（17.4±1.6）μmol/L vs. （8.2±0.3）μmol/L]，充血性心力衰竭发病率也显著高于C1组（28.9% vs. 7.0%），差异有统计学意义（P均＜0.05）。多因素Cox回归分析表明高于10.8 μmol/L的血清HCY（HR=7.175，95%CI：1.152~44.707）是发生心力衰竭的独立预测因子。结论 部分急性心肌梗死患者血清半胱氨酸水平升高，而较高的血清同型半胱氨酸水平是发生心力衰竭的危险因素。

Objective To investigate the changes of homocysteine (Hcy) level and analyze the relationshipbetween Hcy and congestive heart failure (CHF) in patients with acute myocardial infarction (AMI). Methods AMIpatients (n=100, male 84, female 16, aged from 49 to 84 and average age=63.6±3.4) were chosen from Oct. 2012to Oct. 2013. All patients were divided into high Hcy group (Hcy>10.8 μmol/L, H group, n=49) and control group(Hcy<10.8 μmol/L, C group, n=51). The levels of Hcy, brain natriuretic peptide (BNP), left ventricular ejectionfraction (LVEF), creatine kinase (CK) and cardiac troponin T (cTnT) were recorded at hospitalization time, andprevalence of heart failure was recorded after patients discharged from hospital. Results Hcy level was significantlyhigher in H group than that in C group [(17.4±1.4) μmol/L vs. (8.2±0.3) μmol/L, P<0.01]. The comparison inincidence of CHF by using Kaplan-Meier curve showed that CHF incidence was significantly higher in H group thanthat in C group (43.7% vs. 12.5%, P<0.001). At hospitalization time, there were 81 patients with heart function class ofKillip I (without symptoms related to CHF), and 38 in H1 group and 43 in C1 group. The level of serum Hcy [(17.4±1.6)μmol/L vs. (8.2±0.3) μmol/L], and incidence of CHF (28.9% vs. 7.0%) were significantly higher in H1 group thanthat in C1 group (all P<0.05). The results of multi-factor Cox regression analysis showed that level of serum Hcy over10.8 μmol/L was an independent predictive factor for CHF (HR=7.175, 95%CI: 1.152~44.707). Conclusion Thelevel of serum Hcy will increase in some patients with AMI, and higher Hcy level is a risk factor of CHF.