急性心肌梗死经皮冠状动脉介入治疗患者血清同型半胱氨酸水平预测不良心血管事件的价值及其相关性分析

Value of serum Hcy level in predicting adverse cardiovascular events in patients with acute myocardial infarction undergoing PCI intervention and its correlation analysis

目的:探讨血清同型半胱氨酸(Hcy)水平对急性心肌梗死经皮冠状动脉介入治疗(PCI)患者是否发生不良心血管事件的预测价值及其相关性分析。方法:筛选80例急性心肌梗死患者作为研究对象,依照PCI术后是否发生不良心血管事件(MACE)分为非MACE组(n=59)和MACE组(n=21),对比两组患者临床特征与Hcy表达水平,分析Hcy水平对急性心肌梗死患者不良心血管事件的预测价值。根据所有患者的血清Hcy检测结果,将Hcy水平≥11.69μmol/L的患者分为高Hcy组(n=34),将Hcy水平<11.69μmol/L的患者分为低Hcy组(n=46),对比两组患者治疗情况与不良心血管事件发生情况,最后分析Hcy水平与不良心血管事件的相关性。结果:非MACE组与MACE组患者性别、体重指数(BMI)、合并基础疾病情况、饮酒史、吸烟史比较无统计学差异(均P>0.05),两组患者年龄、心功能分级、左室射血分数、TIMI评分、GRACE评分以及Hcy表达水平比较差异有统计学意义(均P<0.05);Logistic回归分析结果表明:TIMI评分、GRACE评分与Hcy为不良心血管事件的独立危险因素(均P<0.05);低Hcy组与高Hcy组患者支架类型、支架长度、他汀类药物和氯吡格雷治疗情况、再发心绞痛、心力衰竭、严重心律失常以及死亡情况比较无统计学差异(均P>0.05);两组患者冠脉病变支数、不良心血管事件总数及再发心肌梗死发生率比较差异有统计学意义(均P<0.05);Spearman相关分析结果显示:Hcy水平与单一不良心血管事件中再发心绞痛、心力衰竭、严重心律失常以及死亡无明显相关性(均P>0.05),Hcy水平与总不良心血管事件及心肌梗死再发心肌梗死呈正相关(均P<0.05)。结论:Hcy水平与急性心肌梗死的常用评分标准TIMI评分、GRACE评分均为不良事件发生预后的独立预测因素,Hcy水平与总不良心血管事件发生率及再发心肌梗死呈正相关。

Objective:To investigate the predictive value of serum homocysteine(Hcy) level in patients with acute myocardial infarction undergoing PCI intervention for the occurrence of adverse cardiovascular events and its correlation analysis.Methods:A total of 80 patients with acute myocardial infarction were selected as the research objects.According to whether adverse cardiovascular events(MACE) occurred after PCI,they were divided into non-MACE group(59 cases) and MACE group(21 cases).The clinical characteristics and Hcy expression level of the two groups were compared.The predictive value of Hcy level in the adverse cardiovascular events of patients with acute myocardial infarction was analyzed.According to the results of Hcy test in all patients,the patients with Hcy level≥11.69 μmol/L were divided into high Hcy group(34 cases),and the patients with Hcy level<11.69 μmol/L were divided into low Hcy group(46 cases).The treatment and adverse cardiovascular events were compared between the two groups.Finally,the correlation between Hcy level and adverse cardiovascular events was analyzed.Results:There was no significant difference in gender,BMI,combined basic diseases,drinking history and smoking history between non-MACE group and MACE group(all P>0.05).The difference of age,cardiac function,left ventricular ejection fraction,TIMI score,GRACE score and Hcy expression level between the two groups was significant(all P<0.05).Logistic regression analysis showed that TIMI score,GRACE score and Hcy level were independent risk factors of adverse cardiovascular events(all P<0.05).There was no significant difference in the number of stent types,stent length,statins and clopidogrel treatment,recurrent angina,heart failure,serious arrhythmia and death between high Hcy group and low Hcy group(all P>0.05),but the difference of the number of coronary artery disease branches,the total number of adverse cardiovascular events and the incidence of recurrent myocardial infarction in the two groups was significant(all P<0.05).Spearman correlation analysis showed that there was no significant correlation between Hcy level and recurrent angina pectoris,heart failure,severe arrhythmia and death in a single adverse cardiovascular event(all P>0.05),but there was a positive correlation between Hcy level and total adverse cardiovascular events and recurrent myocardial infarction(all P<0.05).Conclusion:Hcy level,TIMI and GRACE scores are independent predictors of adverse events.Hcy level was positively correlated with the incidence of total adverse cardiovascular events and the recurrence of myocardial infarction.