血浆同型半胱氨酸与急性心肌梗死患者预后的相关性研究

发布时间：2018-05-25 04:42

本文选题：同型半胱氨酸 + 急性心肌梗死　；参考：《重庆医学》2017年31期

【摘要】：目的探讨血浆同型半胱氨酸(Hcy)水平与急性心肌梗死(AMI)患者远期发生主要心血管不良事件(MACE)的相关性。方法连续纳入2012年3月至2014年12月该院心血管内科住院治疗的AMI患者共326例,Hcy等实验室生化指标均由医院医学检验科按标准流程进行检测。对Hcy水平与MACE发生率进行ROC曲线分析,按Cut-off值11.69μmol/L将研究对象分为Hcy(L)组及Hcy(H)组,收集研究对象的临床基线资料,并定期随访,记录MACE。结果 Hcy(L)组血浆N端B型脑钠钛前体(NT-pro BNP)水平明显低于Hcy(H)组[(501.46±118.35)pg/mL vs.(1 324.11±523.13)pg/mL,P=0.02],而左心室射血分数(LVEF)则明显高于Hcy(H)组[(55.23±9.48)%vs.(50.79±10.68)%,P=0.03]。随访1年后Hcy(H)组LVEF与基线相比明显降低[(45.32±10.18)%vs.(50.79±10.68)%,P0.05],且Hcy(H)组MACE发生风险明显高于Hcy(L)组,校正相关混杂因素后仍差异有统计学意义(P=0.048),而Hcy(L)组LVEF、左心室短轴缩短率(FS)与基线资料相比无明显差异[(54.43±10.68)%vs.(55.23±9.48)%、(28.56±6.21)%vs.(29.22±5.30)%,P0.05]。结论 AMI合并高血浆Hcy水平患者发生远期MACE风险较低血浆Hcy水平者明显增加,预后较差,提示血浆高Hcy水平是AMI患者预后不良可能的独立预测因子之一,但其在AMI发生、发展中的作用机制及Hcy干预治疗能否改善AMI患者预后仍有待进一步研究。
[Abstract]:Objective to investigate the relationship between plasma homocysteine (Hcy) levels and major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI). Methods from March 2012 to December 2014, a total of 326 AMI patients who were admitted to the Department of Cardiovascular Medicine in our hospital were included in this study. The laboratory biochemical indexes such as homocysteine were detected by the standard procedure in the medical laboratory of the hospital. The level of Hcy and the incidence of MACE were analyzed by ROC curve. According to the Cut-off value of 11.69 渭 mol/L, the subjects were divided into two groups. The clinical baseline data of the subjects were collected, followed up regularly and recorded. Results the plasma levels of NT-pro BNPs were significantly lower in Hcyln L group than those in HcylH group [501.46 卤118.35)pg/mL vs.(1 324.11 卤523.13 g / mL P0.002], while the left ventricular ejection fraction (LVEF) was significantly higher than that in HcycyH group [55.23 卤9.48)%vs.(50.79 卤10.68 P0.03]. After one year of follow-up, the LVEF of the Hcy group was significantly lower than that of the baseline group [45.32 卤10.18)%vs.(50.79 卤10.68], and the risk of occurrence of MACE in the Hcy group was significantly higher than that in the HCL group. There was still significant difference after correction of relative confounding factors, but there was no significant difference in LVEF (left ventricular shortening rate and FSs) between the two groups [54.43 卤10.68)%vs.(55.23 卤9.48 10.68)%vs.(55.23 卤28.56 卤5.30]. Conclusion the long-term MACE risk of AMI patients with high plasma Hcy level is significantly higher than that of patients with lower plasma Hcy level, and the prognosis is poor. It suggests that plasma high Hcy level is one of the independent predictors of poor prognosis in AMI patients, but it occurs in AMI. The mechanism of development and whether Hcy intervention can improve the prognosis of AMI patients need further study.
【作者单位】：广西壮族自治区人民医院心血管内科;广西壮族自治区人民医院认知睡眠中心;
【基金】：广西壮族自治区卫生厅自筹经费科研课题(Z2014213) 广西壮族自治区重大科技攻关课题(桂科攻14124003-9)
【分类号】：R542.22

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