血清同型半胱氨酸水平及颈动脉内膜中层厚度在冠心病患者中的临床意义

Clinical significance of homocysteine and carotid intima-media thickness in coronary heart disease

目的探讨冠心病患者血清同型半胱氨酸(Hcy)水平和颈动脉内膜中层厚度(IMT)的关系及两者与冠脉病变程度的相关性.方法选取郑州大学第二附属医院115例疑似冠心病患者,依据冠脉造影结果分为非冠心病组47例(对照组),冠心病组68例(冠心病组),其中冠心病组依据造影结果显示累及血管支数将其分为3个亚组:单支病变组21例,双支病变组22例,三支病变组25例(双支和三支病变合成为多支病变).利用彩色多普勒超声测定受试者颈动脉内膜中层厚度,并对受试者进行相关血生化指标及Hcy水平的检测.应用SPSS 22.0统计软件进行分析.两组间样本均数比较采用t检验;多组样本均数间比较采用方差分析,组间两两比较用LSD法;计数资料采用x2检验;相关分析采用Spearman相关分析.结果冠心病组血清Hcy[(21.59±3.21)μmol/L]和颈动脉IMT水平[(1.21±0.22) mm]均高于对照组[(14.85±1.84)μmol/L,(0.83±1.11) mm],差异有统计学意义(￡=14.252,t=11.970,P均<0.01).冠心病各亚组间血清Hcy和颈动脉IMT水平差异均有统计学意义(F=45.890,F=20.945,P均<0.01).血清Hcy和颈动脉IMT呈正相关(r=0.665,P<0.01);Hcy和颈动脉IMT分别与冠脉病变支数呈正相关(r=0.654、0.493,P均<0.01).结论 Hcy和颈动脉IMT水平与冠心病和冠脉病变程度明显相关,上述两指标有助于冠心病及冠脉病变程度的早期预测.

Objective To investigate the relationship between serum homocysteine (Hcy) level and carotid intima-media thickness (IMT) in patients with coronary heart disease and their correlation with the severity of coronary artery disease. Methods 115 patients with suspected coronary heart disease were selected and divided into non-coronary heart disease group (47 cases, control group) and coronary heart disease group (68 cases, coronary heart disease group) according to coronary angiography results. The coronary heart disease group was divided into three subgroups according to the number of involved vessels shown by angiography results: single vessel lesion group (21 cases), double vessel lesion group (22 cases) and three vessel lesion group (25 cases, double vessel and three vessel lesions combined into multiple vessel lesions). The carotid intima-media thickness of the subjects was measured by color Doppler ultrasound, and the related blood biochemical indexes and Hcy level of the subjects were detected. Statisticalanalysis of data using the statistical product and service solutions 22.0 software. Results The levels of serum Hcy [(21.59±3.21)μmol/L] and carotid artery IMT [(1.21±0.22) mm] in coronary heart disease group were higher than those in control group [(14.85±1.84)μmol/L,(0.83±1.11) mm], the differences was statistically significant (t=14.252, 11.970, P<0.01). There were significant differences in serum Hcy and carotid IMT levels between different subgroups of coronary heart disease (F=45.890, 20.945, P<0.01). There was a positive correlation between serum Hcy and carotid IMT (r=0.665, P<0.01). Hcy and IMT of carotid artery were positively correlated with the number of coronary lesion branches respectively (r=0.654, 0.493, P<0.01). Conclusion Hcy and carotid IMT levels are closely related to coronary heart disease and coronary lesion degree. The above two indexes have certain clinical significance for early prediction of coronary heart disease and coronary lesion degree.