同型半胱氨酸对冠心病合并心力衰竭患者PCI术后死亡的影响

Effect of homocysteine on the death of patients with coronary heart disease and heart failure after PCI

目的探索同型半胱氨酸(Hcy)对冠状动脉粥样硬化性心脏病(冠心病)合并心力衰竭(心衰)患者经皮冠状动脉介入治疗(PCI)术后死亡的影响。方法回顾分析2014年1月至2018年12月于山西医科大学第一医院诊断为冠心病合并心衰,且行PCI术患者284例。根据入院时空腹Hcy水平分为两组:高Hcy组(n=195,Hcy≥15μmol/L)和正常Hcy组(n=89,Hcy<15μmol/L),平均随访(33.6±18.4)月,随访患者术后全因死亡的发生情况。应用卡方检验比较两组间的死亡率,多元Cox回归分析影响患者死亡的独立危险因素。结果正常Hcy组患者血浆Hcy平均水平为(9.90±3.71)μmol/L,高Hcy组血浆Hcy平均水平为(26.51±14.39)μmol/L。高Hcy组男性、高血压患者多,血肌酐水平较正常Hcy组高,其余均无统计学差异(P>0.05);高Hcy组的死亡率显著高于正常Hcy组(14.4%vs. 4.5%,P=0.015);多因素Cox回归分析显示,年龄≥65岁(OR=1.122,P=0.001)、高肌酐水平(OR=1.014,P=0.040)、高Hcy水平(OR=3.858,P=0.043)为冠心病合并心衰患者PCI术后发生死亡的独立危险因素。结论 Hcy水平升高的冠心病合并心衰患者PCI术后死亡风险更高。高Hcy是冠心病合并心衰患者PCI术后死亡的独立危险因素。

Objective To investigate the effect of homocysteine(Hcy)on mortality after percutaneous coronary intervention(PCI)in patients with coronary heart disease and heart failure.Methods A retrospective analysis was conducted on 284 patients who were diagnosed with coronary heart disease and heart failure in the First Hospital of Shanxi Medical University from January 2014 to December 2018 and underwent PCI.According to the level of fasting Hcy at admission,the patients were divided into two groups:high Hcy group(n=195,Hcy<15μmol/L)and normal Hcy group(n=89,Hcy<15μmol/L),with an average follow-up(33.6<18.4)months,and the occurrence of postoperative death.Chi-square test was used to compare mortality between the two groups,and multivariate Cox regression was used to analyze the independent risk factors affecting patient mortality.Results The average level of plasma Hcy in normal Hcy group was(9.90+3.71)micromol/L,and that in high Hcy group was(26.51+14.39)micromol/L.There were more males and hypertensive patients in the high Hcy group,and the serum creatinine level was higher than that in the normal Hcy group.The other baseline data showed no statistical difference(P>0.05);the mortality rate in the high Hcy group was significantly higher than that in the normal Hcy group(14.4%vs.4.5%,P=0.015).Multivariate Cox regression analysis showed that age<65 years(OR=1.122,P=0.001),high creatinine level(OR=1.014,P=0.040),and high Hcy level(OR=3.858,P=0.043)were independent risk factors for death after PCI in patients with coronary heart disease and heart failure.Conclusion Patients with elevated Hcy levels have a higher risk of death after PCI.High Hcy is an independent risk factor for death after PCI in patients with coronary heart disease and heart failure.