同型半胱氨酸与老年冠心病合并2型糖尿病患者心功能的相关性研究

Relationship between homocysteine and heart function in elderly patients with coronary heart disease and type 2 diabetes mellitus

目的探讨同型半胱氨酸(HCY)与老年冠心病合并2型糖尿病患者心功能的关系,为临床治疗和干预提供理论依据。方法选取2013年6月至2015年6月期间就诊于我院老年病科的500例冠心病合并2型糖尿病老年患者作为研究对象,选取同期于我院做健康查体的50例健康老年人作为正常对照组。根据心功能分级标准将患者有无心力衰竭(HF)分为HF组343例和非HF组157例。比较三组受检者的HCY、空腹血糖(FPG)及甘油三酯(TG)、胆固醇(TC)、糖化血红蛋白(HBA1C)、脑钠肽(BNP)及左心室射血分数(LVEF)的差异。结果 HF组患者的FPG[(9.3±4.2)mmol/L]、HBA1C[(9.01±2.45)%]、TG[(1.76±0.58)mmol/L]、TC[(6.13±1.01)mmol/L]水平均明显高于非HF组[(7.3±2.6)mmol/L、(7.66±2.36)%、(1.43±0.61)mmol/L、(5.02±0.43)mmol/L]及正常对照组[(5.6±3.1)mmol/L、(4.62±0.47)%、(1.16±0.39)mmol/L、(4.21±0.52)mmol/L],差异均具有统计学意义(P<0.05)。HF组患者HCY[(18.5±7.2)μmol/L]、LVEF[(51.3±7.5)%]、BNP[(3212.5±4134.2)pg/m L]均明显高于非HF组[(11.9±3.0)μmol/L、(59.2±4.4)%、(369.3±780.5)pg/m L]与正常对照组[(7.3±1.6)μmol/L、(69.2±5.5)%、(79.8±31.2)pg/m L],差异均具有统计学意义(P<0.05)。Spearman相关性分析发现,HCY与心功能分级之间存在正相关性(r=0.51,P<0.05),HCY与LVEF之间存在负相关性(r=-0.35,P<0.05)。结论 HCY可以反映老年冠心病合并2型糖尿病患者的心功能,患者心功能越差,HCY水平越高。

Objective To investigate the relationship of homocysteine(HCY) and heart function in elderly patients with coronary heart disease and type 2 diabetes mellitus, and provide theoretical basis for clinical treatment and intervention. Methods From June 2013 to June 2015, 500 patients with coronary heart disease and type 2 diabetes mellitus in our hospital were selected as the research objects. Fifty cases of healthy elderly persons in our hospital for health examination were selected as a normal control group during the same period. According to the classification criteria of heart function, patients with heart failure were divided into heart failure(HF) group(n=157) and non HF group(n=343). The difference of HCY, fasting insulin(FPG), triglyceride(TG), cholesterol(TC), HBA1 c, BNP and LVEF in HF group and non HF group were compared. Results The parameters of FPG, HBA1 C, TG and TC in HF group [(9.3±4.2) mmol/L,(9.01±2.45)%,(1.76±0.58) mmol/L,(6.13±1.01) mmol/L, respectively] were significantly higher than those in non HF group [(7.3 ± 2.6) mmol/L,(7.66 ± 2.36)%,(1.43 ± 0.61) mmol/L,(5.02 ± 0.43) mmol/L, respectively] and normal control group [(7.3±2.6) mmol/L,(7.66±2.36)%,(1.43±0.61) mmol/L,(5.02±0.43) mmol/L, respectively], P<0.05. The parameters of HCY, LVEF, BNP in HF group [(18.5±7.2) μmol/L,(51.3±7.5)%,(3 212.5±4 134.2) pg/m L] were significantly higher than those in non HF group [(11.9±3.0) μmol/L,(59.2±4.4)%,(369.3±780.5) pg/m L] and normal control group[(7.3±1.6) μmol/L,(69.2±5.5)%,(79.8±31.2) pg/m L], P<0.05. Spearman correlation analysis showed there was a positive correlation between HCY and cardiac function(r=0.51, P<0.05), and there was a negative correlation between HCY and LVEF(r=-0.35, P<0.05). Conclusion HCY can reflect the cardiac function of elderly patients with coronary heart disease complicated with type 2 diabetes mellitus. The worse the patient’s heart function, the higher the HCY level.