高龄冠状动脉粥样硬化性心脏病患者血清同型半胱氨酸与叶酸维生素B_(12)及胰岛素抵抗的相关性分析

Correlation of serum HCY with folic acid,vitamin B_(12) and insulin resistance in elderly patients with coronary heart disease

目的探讨高龄冠状动脉粥样硬化性心脏病(CHD)患者血清同型半胱氨酸(HCY)水平与叶酸、维生素B_(12)、胰岛素抵抗的相关性。方法选择哈尔滨医科大学附属第四医院老年病科2019年1月至2020年12月住院高龄CHD患者80例,年龄80~98岁,平均(89±3)岁,入选者分为HCY<15μmol/L组(A组)、15μmol/L≤HCY≤20μmol/L组(B组)、HCY>20μmol/L组(C组)。观察入选患者年龄及血脂等临床生化指标变化,分析各组患者伴发相关疾病差异。酶联免疫吸附试验(ELISA)检测血胰岛素(FINS)、叶酸、维生素B_(12)水平,并计算胰岛素抵抗指数(HOMA-IR)=FINS(mU/L)×空腹血糖(FBG)(mmol/L)/22.5。结果①入选高龄CHD患者80例,A组36例,B组21例,C组23例,各组患者年龄、性别差异无统计学意义(P>0.05);②C组患者肌酐、尿酸高于A、B 2组(P<0.05),总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)、FBG、超敏C反应蛋白(hs-CRP)等各组间差异无统计学意义(P>0.05);③C组患者糖尿病、慢性肾衰竭、下肢动脉硬化闭塞症的发生率高于A、B 2组(P<0.05),各组患者伴发高血压、感染性疾病、心力衰竭、心房纤颤差异无统计学意义(P>0.05);④C组患者FINS、HOMA-IR水平高于A、B 2组,其中FINS C组与A、B组之间差异有统计学意义(P<0.05),HOMA-IR C组与A组之间差异有统计学意义(P<0.05)。叶酸、维生素B_(12)水平C组较A、B 2组低,且C组与A、B组之间差异均有统计学意义(P<0.05)。结论高龄CHD患者血清HCY水平升高,胰岛素抵抗水平增高,叶酸、维生素B_(12)水平降低。

Objective To investigate the correlation of serum homocysteine(HCY)level with folic acid,vitamin B_(12) and insulin resistance in elderly patients with coronary heart disease(CHD).Methods Included were a total of eighty elderly CHD patients who stayed in Department of Geriatrics,Fourth Affiliated Hospital of Harbin Medical University,between January 2019 and December 2020.The included patients,with a mean age of(89±3),were divided into groups A(HCY<15μmol/L),B(15μmol/L≤HCY≤20μmol/L group),and C(HCY>20μmol/L).The patients were recorded for their age and changes in clinical biochemical indicators such as blood lipids.The difference in comorbidities in each group was analyzed.Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of serum insulin(FINS),folic acid and vitamin B_(12).Insulin resistance(HOMA-IR)was calculated as FINS(mIU/L)×FBG(mmol/L)/22.5.Results①Eighty elderly patients with CHD were enrolled,with 36 in group A,21 in group B,and 23 in group C.There was no significant difference in age and gender between groups(P>0.05).②The patients in group C had higher levels of creatinine and uric acid than those in groups A and B(P<0.05).There were no differences in total cholesterol(TC),triglyceride(TG),low-density lipoproteincholesterol(LDL-C),fasting blood glucose(FBG),and high-sensitivity C-reactive protein(hs-CRP)between groups(P>0.05).③The prevalence of diabetes,chronic renal failure and lower extremity arteriosclerosis obliterans in group C was higher compared with groups A and B(P<0.05).However,there were no significant differences in hypertension,infectious diseases,heart failure,and atrial fibrillation between groups(P>0.05).④The group C showed higher levels of FINS and HOMA-IR,but lower levels of folic acid and vitamin B_(12),compared to groups A and B,with a significant difference between groups C and group A and B(P<0.05).Conclusion With the increase of serum HCY level,elderly CHD patients tend to show increasing insulin resistance and decreasing levels of folic acid and vitamin B_(12).