高同型半胱氨酸血症与35岁以下青年患者冠心病严重程度的关系

Association between hyperhomocysteinemia and the severity of coronary heart disease among young patients below 35 years of age

目的:探讨高同型半胱氨酸血症(HHCY)对≤35岁青年冠心病患者冠状动脉病变严重程度的影响。方法:入选因疑似冠心病来北京安贞医院行冠状动脉造影检查,并被确诊为冠心病的青年患者(18-35岁)978例。将患者分为HHCY组和非HHCY组。用Gensini评分评估冠心病的严重程度。采用线性回归分析明确HHCY与冠状动脉病变严重程度的关系。结果:在入选患者中546例(55.8%)伴有高同型半胱氨酸血症。与非HHCY组(432例)相比,HHCY组急性心肌梗死的比例更高(55.7%vs.46.1%,P=0.003),LVEF更低[60(53,65)%vs.61.5(56,66)%,P=0.009],冠状动脉多支血管病变的比例(53.1%vs.46.5%,P=0.046)和Gensini评分[40(20,72)vs.32(16,48)分,P<0.001]也明显升高。多因素线性回归分析显示HHCY是冠状动脉病变严重程度的危险因素(OR=9.536,95%CI:5.111-13.961,P<0.001)。结论:高同型半胱氨酸血症与35岁以下青年冠心病患者冠状动脉病变严重程度明显相关。

Objective:To investigate the association between hyperhomocysteinemia(HHCY)and the severity of coronary heart disease(CHD)among young patients below 35 years of age.Methods:978 young patients,18-35 years of age,diagnosed with CHD and underwent coronary angiography were enrolled in the present study.Patients were divided into two groups according to the definition of HHCY.The Gensini score was used to assess the severity of CHD.Univariate and multivariate liner regression analysis were used to analyze the association between HHCY and CHD severity.Results:55.8%(546 cases)of enrolled patients had HHCY.Patients in HHCY group had a higher prevalence of male gender and hyperuricemia,but a lower prevalence of diabetes compared with patients in non-HHCY group.Moreover,prevalence of acute myocardial infarction(55.7%vs.46.1%,P=0.003)and coronary multi-vessel lesions(53.1%vs.46.5%,P=0.046)as well as the Gensini score[40(20,72)vs.32(16,48),P<0.001]were significantly higher,while the value of left ventricular ejection fraction was obviously lower[60%(53%,65%)vs.61.5%(56%,66%),P=0.009]in HHCY group than in non-HHCY group.Multivariate logistic regression analyses showed that after adjusting for age,male,body mass index,smoker,hypertension,diabetes,hypertriglyceridemia,hypercholesterolemia,high low-density lipoprotein cholesterol,low high-density lipoprotein cholesterol,family history of CHD and hyperuricemia,HHCY was an independent risk factor of CHD severity,as assessed by the Gensini score,in young adults with CHD(OR=9.536,95%CI:5.111-13.961,P<0.001).Conclusions:HHCY is signifi-cantly associated with the severity of CHD in young adults below 35 years of age.