同型半胱氨酸和脂蛋白a对冠心病影响的性别差异性分析

Analysis of gender differences in coronary heart disease by homocysteine and lipoprotein(a)

目的探讨血清同型半胱氨酸(Hcy)和脂蛋白a[Lp(a)]对冠状动脉粥样硬化性心脏病(冠心病)影响的性别差异。方法根据冠状动脉造影结果将619例拟诊冠心病的患者分为冠心病组(371例)、对照组(248例),统计入选患者的年龄、性别、高血压病史、糖尿病病史、吸烟史、饮酒史,检测各组患者血清Hcy、Lp(a)、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血糖(GLU)的水平。根据性别分组,分析各组患者之间血清Hcy及Lp(a)的差异,并通过多元Logistic回归模型及Spearman相关分析对冠心病的多项危险因素进行分析。结果冠心病组患者血清Hcy、Lp(a)水平高于对照组(P<0.05);男性患者冠心病组与对照组Hcy、Lp(a)水平无明显差异(P>0.05),女性冠心病组患者血清Hcy及Lp(a)水平明显高于对照组(P<0.05);多元Logistic回归分析显示Hcy、Lp(a)、Hcy联合Lp(a)为女性冠心病的独立危险因素;女性Hcy及Lp(a)水平与Gensini评分呈正相关(P<0.05)。结论Hcy、Lp(a)为冠心病的独立危险因子,对冠心病的影响具有性别差异,其与女性冠心病冠状动脉病变严重程度相关。

Objective To explore the gender differences of serum homocysteine(Hcy)and lipoprotein(a)[Lp(a)]on coronary heart disease.Methods According to the results of coronary angiography,619 patients with coronary heart disease were divided into the coronary heart disease group(371 cases)and the control group(248 cases),the factors were investigated in all groups including age,gender,and history of hypertension,diabetes,smoking and drinking.The levels of serum Hcy,Lp(a),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),Low-density lipoprotein(LDL),blood glucose(GLU)were detected.The differences of serum Hcy and Lp(a)between the groups were analyzed according to gender,and multiple risk factors for coronary heart disease were analyzed by multivariate Logistic regression model and Spearman correlation analysis.Results The levels of serum Hcy and Lp(a)in the coronary heart disease group were higher than those in the control group(P<0.05).There was no significant difference of Hcy and Lp(a)levels in male between the control group and the coronary heart disease group(P>0.05).The levels of Hcy and Lp(a)in women in the coronary heart disease group were significantly higher than those in the control group(P<0.05).Multivariate Logistic regression analysis showed that Hcy,Lp(a),Hcy combined with Lp(a)were independent risk factors of coronary heart disease in women;Hcy and Lp(a)levels were positively correlated with Gensini scores in women(P<0.05).Conclusion Hcy and Lp(a)are independent risk factors for coronary heart disease.The effect on coronary heart disease is gender-related,which is related to the severity of coronary artery disease in women with coronary heart disease.