血清同型半胱氨酸水平对急性ST段抬高型心肌梗死患者预后的影响

Effect of Serum Homocysteine Level on the Prognosis of Patients with Acute ST-Segment Elevated Myocardial Infarction

目的分析血清同型半胱氨酸(Hcy)水平对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2012年12月至2014年10月我院确诊的STEMI并经皮冠状动脉介入(PCI)治疗的340例患者,根据入院时血清Hcy水平分为正常水平组(N-Hcy组,Hcy≤19.98μmol/L,n=236)、高水平组(H-Hcy组,Hcy>19.98μmol/L,n=104)。随访患者术后全因死亡及主要心血管不良事件发生情况,通过COX回归分析血清Hcy水平对STEMI患者预后的影响。结果与N-Hcy组比较,H-Hcy组既往患有卒中和肾功能不全患者较多,左心室射血分数相对较低(P=0.015);H-Hcy组患者左主干病变比例及三支病变比例较高,且术中主动脉内球囊反搏(IABP)植入比例较高(P=0.040)。H-Hcy组术后随访全因死亡及心源性死亡发生率显著高于N-Hcy组(P<0.001)。COX回归分析显示,血清Hcy水平是STEMI患者PCI术后长期预后的独立预测因素。结论合并高水平Hcy的STEMI患者有更高的全因死亡及心源性死亡风险,血清Hcy水平是STEMI患者预后的独立预测因素。

Objective To examine the relationship between the serum homocysteine(Hcy)levels and prognosis of patients with acute ST-segment elevated myocardial infarction(STEMI).Methods From December 2012 to October 2014,340 consecutive patients with acute STEMI who underwent percutaneous coronary intervention(PCI)were enrolled.The patients were stratified into 2 groups according to their serum Hcy levels on admission as follows:the N-Hcy group(Hcy≤19.98μmol/L,n=236)and H-Hcy group(Hcy>19.98μmol/L,n=104).Then,the effect of the serum Hcy level on prognosis was studied using the COX regression analysis.Results Compared with the N-Hcy group,the H-Hcy group had a higher proportion of patients with stroke and renal insufficiency in the past,but with a lower left ventricular ejection fraction(LVEF).The proportions of patients with left main coronary artery disease and triple-vessel disease in the H-Hcy group were higher than those in the N-Hcy group.The proportion of intra-aortic balloon counterpulsation(IABP)implantation was higher in the H-Hcy group.Postoperative follow-up results indicated that the incidence rates of all-cause and cardiac deaths were higher in the H-Hcy group than in the N-Hcy group.The multivariate COX analysis revealed that serum Hcy level was an independent predictor of prognosis in the patients with acute STEMI who underwent PCI after correction of various clinical factors.Conclusion High Hcy level is associated with higher all-cause and cardiac mortality rates,and is an independent predictor of prognosis in the STEMI patients in this study.