血清同型半胱氨酸及一氧化氮水平与冠状动脉慢血流现象的相关性研究

Correlation between serum homocysteine and nitric oxide levels and coronary slow flow phenomenon

目的:测定冠状动脉慢血流现象(CSFP)患者血清同型半胱氨酸(Hcy)、一氧化氮(NO)水平,评价两者与CSFP的相关性,分析两者对CSFP的预测价值。方法:选取华润武钢总医院2020年8月至2021年8月,心内科因胸痛住院、心电图提示ST-T改变,行经皮冠状动脉造影未见心外膜冠状动脉有狭窄或明显狭窄(<50%)患者92例,通过校正TIMI血流计帧法(CTFC)计算各冠状动脉血流帧数,将冠状动脉血流平均帧数> 27帧定义为CSFP,将92例患者分为慢血流现象组(CSFP组)43例及非慢血流现象组(NCSFP)49例,收集两组患者的一般临床资料、测定Hcy、NO、TG、TC等血清学指标,应用多因素Logistic回归分析确定CSFP的危险因素,通过受试者工作曲线(ROC)进一步分析Hcy及NO对CSFP的预测价值。结果:CSFP组Hcy水平明显高于NCSFP组[(20.39±1.70)vs.(17.57±1.57),P<0.05],CSFP组NO水平明显低于NCSFP组[(21.96±2.68)vs.(27.00±3.95),P <0.05],Logistic回归分析结果表明Hcy是CSFP的危险因素(OR=2.981, P <0.0001),NO是CSFP的保护因素(OR=0.588, P <0.000);ROC分析结果表明Hcy曲线下面积为0.880,预测CSFP的灵敏度为93.02,特异度为69.39,NO曲线下面积为0.853,预测CSFP的灵敏度为88.4,特异度为73.5。结论:血清NO水平降低及Hcy水平升高是CSFP的危险因素,两者对CSFP有较高的预测价值。

Objective:To determine the serum levels of homocysteine(Hcy)and nitric oxide(NO)in patients with coronary slow flow phenomenon(CSFP),and to evaluate their correlation with CSFP,and to analyze their predictive value for CSFP.Methods:From August 2020 to August 2021,92 patients with chest pain in the CR&WISCO General Hospital and ST-T changes indicated by electrocardiogram were selected.Percutaneous coronary angiography showed no epicardial coronary artery stenosis or obvious stenosis(<50%). The blood flow frames of each coronary artery were calculated by corrected TIMI frame count (CTFC). A total of 92 patients were divided into slow flow phenomenon group (CSFP group) (n =43) and non-slow flow phenomenon group (NCSFP group) (n =49). The general clinical data of the two groups were collected, and the serological indexes such as Hcy, NO, TG and TC were measured. The independent risk factors of CSFP were determined by multivariat logistic regression analysis, and the predictive value of Hcy and NO on CSFP was further analyzed by receiver operating characteristic (ROC) curve. Results: There was no significant difference in gender, age, history of hypertension, diabetes, smoking history, BMI, serum FPG, HbA1C, Cr, TG, TC, LDL, HDL, ALT, AST levels between the two groups (P>0.05). The level of Hcy in CSFP group was significantly higher than that in NCSFP group[( 20.39±1.70 ) vs. ( 17.57±1.57 ), P < 0.05]. The level of NO in CSFP group was significantly lower than that in NCSFP group[ ( 21.96±2.68 ) vs. ( 27.00±3.95 ), P<0.05]. Logistic regression analysis showed that Hcy was a risk factor for CSFP ( OR=2.981, 95%CI:1.764-5.038, P < 0.0001 ). NO was a protective factor for CSFP ( OR=0.588, 95%CI:0.444-0.777, P < 0.0001 ). ROC analysis showed that the area under the curve of Hcy was 0.880, the sensitivity and specificity of predicting CSFP were 93.02 and 69.39, and the area under the curve of NO was 0.853, the sensitivity and specificity of predicting CSFP were 88.37 and 73.47. Conclusions: Decreased serum NO level and increased serum Hcy level are independent risk factors for CSFP, and they have high predictive value for CSFP.