高同型半胱氨酸血症与冠心病关系的临床研究

Study on the relation between hyperhomocysteinemia and coronary artery disease

目的 :研究血浆同型半胱氨酸 (Hom ocysteine,Hcy)水平与冠心病及其危险因素的关系 ,探讨冠心病患者血浆 Hcy水平变化的临床意义 ,以明确 Hcy在冠心病发生、发展中的作用。 方法 :采用横断面调查的方法选择我院心内科住院并行冠状动脉造影术的 110例病人 ,按冠状动脉造影结果分为冠状动脉狭窄 (CAS)组 (74例 )和冠状动脉正常 (CAN)组 (36例 ) ,并用高效液相色谱法测定血浆 Hcy水平。结果 :(1) CAS组血浆 Hcy水平明显高于CAN组 (P <0 .0 1) ,CAS组中高 Hcy血症占 4 0 .5 4 % ,高于 CAN组 (13.89% ) (P <0 .0 1) ;CAS组男性血浆 Hcy水平高于 CAN组 (P <0 .0 1) ,但 CAS组和 CAN组女性之间没有差异。另外 ,0、1、2、3支血管病变者血浆 Hcy浓度呈逐级增高趋势 ,1支与 3支病变组比较差异有统计学意义 (P <0 .0 5 )。 (2 )经多因素非条件 L ogistic回归分析显示 ,冠心病的其他危险因素有 :吸烟史 (OR=3.16 )、甘油三酯 (OR=2 .30 )、Hcy(OR=1.10 )。结论:冠心病患者血浆 Hcy水平明显升高 ,高 Hcy血症所占比例较大 ,而 Hcy对男性冠心病患者的影响可能更显著 ,并显示随着冠状动脉病变支数的增加 ,血浆 Hcy水平呈逐级上升趋势。提示高 Hcy血症是冠心病重要的独立危险因素。

Objective: To investigate the correlation between plasma homocysteine (Hcy) level and coronary heart disease (CHD) in the population in Xinjing, and to explore the clinical implication of fluctuations in plasma Hcy level of CHD patients, so as to make clear the involvement of Hcy in the pathogenesis of CHD. Methods: Using the cross sectional method, we collected coronary angiographic data of 110 patients admitted by the Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University. The patients were divided into 2 groups according to their coronary angiographic results, with 74 cases in the coronary artery stenosis (CAS) group and 36 in the normal coronary artery (CAN) group. High performance liquid chromatography with fluorescence detection was used to assess the level of plasma Hcy in the patients. Results: (1) Plasma Hcy level in the CAS group (17.40±10.95 μmol/L) was significantly higher than the CAN group (11.78±4.56 μmol/L, P<0.01). In the CAS group, 40.54% of the patients were found to have hyperhomocysteinemia, significantly higher than in the CAN group (13.89%, P< 0.01) . The plasma Hcy level in the males of CAS group (18.23±11.48 μmol/L) was significantly higher than that in the CAN group (12.46±5.75 μmol/L, P<0.01). However, the plasma Hcy level of the female of both groups was not statistically significant. In patients with lesions in 1,2 and 3 vessels, their Hcy level tended to increase, with the number of vessel to be involved. A significant discrepancy was found between Hcy levels in single and triple vessel groups. (2) Multivariatenon conditional logistic regressive analysis indicates that smoking history (OR=3.16), triglyceride level (OR=2.30) and Hcy level (OR=1.10) all were significantly related to OR value of CHD. Conclusion: There is a significant rise in the plasma Hcy level in the population with CHD in Xinjiang in which the incidence of hyperhomocysteinemia is much higher than the population without CHD. The effect of homocysteine is more obvious on male patients. Higher Hcy level is also associated with the increased number of coronary arteries with stenosis. That indicates that hyperhomocysteinemia can be an independent risky factor for coronary heart disease.