高同型半胱氨酸对急性心肌梗死合并高血压患者行急诊PCI术后6个月心功能及死亡的影响

Effect of Hyperhomocysteinemia on Cardiac Function and Mortality of Patients with Acute Myocardial Infarction Concomitant Hypertension underwent Primary Percutaneous Coronary Intervention after 6 Months

目的回顾性分析高同型半胱氨酸(homocysteine,Hcy)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)合并高血压患者急诊行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后6个月左心功能及死亡的影响。方法纳入2015年6月至2016年12月期间因STEMI合并高血压在联勤保障部队第九二O医院心内科行急诊PCI的患者78例,依据Hcy水平是否≥15.0μmol/L分为STEMI合并H型高血压组、STEMI合并单纯高血压组各39例。比较两组患者一般资料如人口学特征、合并症、术前用药情况、相关检验结果等,PCI术中及住院期间相关数据如冠脉病变情况、术中手术情况、辅助治疗以及术后用药等,术后6个月左室射血分数及累计死亡的情况。结果性别、血肌酐、Hcy、病变血管支数对比组间有差异,具有统计学意义(P<0.05)。住院左心室射血分数(left ventricular ejection fractions,LVEF)、6月LVEF、两次LVEF差值以及6月累计死亡,差异均无统计学意义(P>0.05)。结论高Hcy对STEMI合并高血压患者行急诊PCI术后6月心功能及累计死亡无影响。

Objective To identify the effect of hyperhomocysteinemia on cardiac function and mortality in patients with acute ST-segment elevation myocardial infarction concomitant hypertension underwent primary PCI after 6 months.Methods 192 patients in the Department of Cardiology,920 th Hospital of Joint Logistics Support Force with acute ST-segment elevation myocardial infarction concomitant hypertension who had undergone primary PCI was recruited from June 2015 to December 2016.116 cases were excluded from the study owing to their incomplete follow-up data.The total remaining 78 patients were divided into two groups according to the level of homocysteine(Hcy)≥15.0 mol/L:STEMI combined with H-type hypertension group(n=39)and the STEMI combined with hypertension group(n=38).Baseline data of the two groups,relevant data during hospitalization and PCI,and left ventricular ejection fraction and cumulative mortality 6 months after surgery were compared.Results There were statistically significant differences in male proportion,serum creatinine and HCY between the two groups(P<0.05).There was statistically significant difference in the number of lesion vessels which was higher in the high Hcy group than in the control group(P<0.012).No statistically significant difference was showed in left ventricular ejection fraction at the time of hospitalization and the 6 th month,the difference value between two left ventricular ejection fractions and the cumulative death at the 6 th month between the two groups(all P>0.05).Conclusion Hyperhomocysteine has no effect on cardiac function and cumulative mortality 6 months after primary PCI in patients with acute ST-segment elevation myocardial infarction concomitant hypertension.