血清同型半胱氨酸、高敏C反应蛋白、胱抑素C水平与冠状动脉粥样硬化的关系

Connection of homocysteine, hig sensitivity C-reative protein and cystatin C with coronary atherosclerosis

目的探讨血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、胱抑素C(Cys C)水平,分析其与冠状动脉粥样硬化的关系。方法选取2016年8月～2018年1月在南京医科大学第二附属医院东院心血管科住院的245例检查过多排螺旋CT冠脉成像(MSCTCA)的患者,根据冠状动脉有无狭窄≥50%分为无冠脉狭窄组(90例),冠脉狭窄组(155例)(其中伴高血压病者116例);冠脉狭窄组按狭窄≥50%的支数分为单支病变组(48例)、双支病变组(45例)、多支病变组(62例)。按冠状动脉狭窄程度分级分为4组:Ⅰ级病变组:管腔面积的缩小1%～25%(30例);Ⅱ级病变组:管腔面积的缩小<25%～50%(60例);Ⅲ级病变组:管腔面积的缩小<50%～75%(120例);Ⅳ级病变组:管腔面积的缩小<75%～100%(35例)。比较不同冠状动脉粥样硬化病变患者血清Hcy、hs-CRP、Cys C水平。结果与无冠脉狭窄组比较,冠脉狭窄组血清Hcy、hs-CRP、Cys C明显升高(P <0.05);与冠脉狭窄组比较,伴高血压病的冠脉狭窄组血清Hcy、hs-CRP、Cys C明显升高(P <0.05)。与无冠脉狭窄组比较,其他3组血清Hcy、hs-CRP、Cys C水平明显升高(P <0.05);与单支病变组比较,双支病变组、多支病变组血清Hcy、hs-CRP、Cys C水平明显升高(P <0.05);与双支病变组比较,多支病变组血清Hcy、hs-CRP明显升高(P <0.05)。与Ⅰ级病变组比较,Ⅱ～Ⅲ级病变组血清Hcy、hs-CRP、Cys C明显升高,Ⅳ级病变组Hcy、hs-CRP明显升高(P <0.05);与Ⅱ级病变组比较,Ⅲ级病变组血清Hcy、hs-CRP、Cys C水平明显升高,且Ⅳ级病变组Hcy、hs-CRP明显升高(P <0.05);与Ⅲ级病变组比较,Ⅳ级病变组血清Hcy、hs-CRP水平明显升高(P <0.05)。结论血清高水平的Hcy、hs-CRP、Cys C和冠状动脉粥样硬化相关。联合常规生化检验,动态检测血清Hcy、hs-CRP、Cys C有助于评估冠状动脉粥样硬化狭窄病变支数和狭窄严重程度,可指导临床治疗,有利于提高冠状动脉粥样硬化患者临床疗效及改善预后。

Objective To explore the connection between levels of serum homocysteine(Hcy),high sensitivity C-reative protein(hs-CRP)and cystatin C(Cys C)and coronary atherosclerotic.Methods A total of245patients accepting Multi-Slics spiral CT coronary angiography(MSCTCA)in Department of Cardiology,the Second Affiliated Hospital of Nanjing Medical University from August2016to January2018were selected.According to whether coronary stenosis≥50%or not,all the cases were divided into non coronary stenosis group(90cases)and coronary stenosis group(155cases)(116patients with hypertention).According to number of affected vessel with coronary stenosis≥50%,all the cases were divided into single vessel affected group(48cases),double vessels affected group(45cases),multiple vessels affected group(62cases).According to degree of coronary artery stenosis,the patients were divided into four groups:degreeⅠgroup:reduced lumen area1%-25%(30cases);degreeⅡgroup:reduced lumen area<25%-50%(60cases);degreeⅢgroup:reduced lumen area<50%-75%(120cases);degreeⅣgroup:reduced lumen area<75%-100%(35cases).Hcy,hs-CRP and Cys C were compared among the coronary atherosclerotic with different types.Results Compared with the non coronary stenosis group,Hcy,hs-CRP and Cys C coronary in the stenosis group were higher(P<0.05).Compared with coronary stenosis group,Hcy,hs-CRP and Cys C of patients with hypertension of coronary stenosis group were higher(P<0.05).Compared with the non coronary stenosis group,Hcy,hs-CRP,Cys C were higher in the other groups(P<0.05).Compared with the single vessel affected group,Hcy,hs-CRP in double vessels affected group and multiple vessels affected group were higher(P<0.05).Compared with the dagreeⅠgroup,Hcy,hs-CRP,Cys C were higher in the degreeⅡ-Ⅲgroups,Hcy,hs-CRP in the degreeⅣgroup were higher(P<0.05).Compared with the dagreeⅡgroup,Hcy,hs-CRP,Cys C in the degreeⅢgroup were higher,Hcy,hs-CRP in the degreeⅣgroup were higher(P<0.05).Compared with the dagreeⅢgroup,Hcy,hs-CRP in the degreeⅣgroup were higher(P<0.05).Conclusion High levels of serum Hcy,hs-CRP and Cys C have relationship with coronary atherosclerosis.Combined with normal test,regularly testing the levels of serum Hcy,hs-CRP and Cys C is helpful for the evaluation of coronary artery affected vessel number and stenosis degree,which can guide clinical treatment and improve coronary atherosclerosis patients′treatment efficacy and prognosis.