淺論血漿同型半胱氨酸水平與冠狀動(dòng)脈病變關(guān)系的臨床研究

1、淺論血漿同型半胱氨酸水平與冠狀動(dòng)脈病變關(guān)系的臨床研究         【摘要】  目的 探討血漿同型半胱氨酸（HCY）水平與冠狀動(dòng)脈病變的相關(guān)性。方法 選擇臨床擬診冠心病病例132例，根據(jù)造影結(jié)果分為4組，即：A組，冠脈造影除外冠心?。o(wú)狹窄或狹窄50%）（25例）；B組，單支病變（35例）；C組，雙支病變（35例）；D組，三支病變（37例）。冠脈造影前取靜脈血及插管時(shí)取動(dòng)脈血，采用免疫競(jìng)爭(zhēng)法測(cè)定同型半胱氨酸水平。結(jié)果 冠脈造影證實(shí)冠心病者同型半胱氨酸水平高于非冠心病者。動(dòng)脈血組同型半胱氨酸水平：?jiǎn)沃Р∽?/p>

2、組高于非冠心病組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)；雙支病變組高于單支病變組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)；三支病變組高于雙支病變組，差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。靜脈血組同型半胱氨酸水平：?jiǎn)沃Р∽兘M高于非冠心病組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)；雙支病變組高于單支病變組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)；三支病變組高于雙支病變組，差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 高同型半胱氨酸水平與冠狀動(dòng)脈病變相關(guān)，靜脈血同型半胱氨酸可替代動(dòng)脈血同型半 胱氨酸作為診斷冠心病及復(fù)雜程度的指標(biāo)之一。 【關(guān)鍵詞】  冠狀動(dòng)脈疾病 同型半胱氨酸 危險(xiǎn)因素 冠狀動(dòng)脈造影術(shù)   Abs

3、tract：Objective  To investigate the relationship between plasma homocysteine and severity of coronary artery lesion. Methods  132 patients diagnosed clinically coronary heart disease(CHD) were selected and divided into four groups according to the outcome of coronary arteriography: group A

4、, including 25 patients without CHD (no lesion or the severity of lesion within 50% in coronary arteries), group B, 35 patients with single branch lesion, group C, 35 patients with double branch lesion， group D, 37 patients with three branch lesion.  We collected venous blood and artery blood b

5、efore coronary arteriography and measured plasma homocysteine. Results  There is higher plasma homocysteine level in patients with CHD than patients without CHD(P0.05). The level of plasma homocysteine is higher in patients with single branch lesion than without CHD(P0.05).The level of plasma h

6、omocysteine is higher in patients with double branch lesion than with single branch lesion(P0.05); The level of plasma homocysteine is higher in patients with three branch lesion than with double branch lesion(P0.05). It happens within not only venous blood group but also artery blood group.  C

7、onclusions   The level of plasma homocysteine is correlated with severity of CHD. The level plasma homocysteine of venous blood can replace artery blood to diagnose CHD and evaluate severity of it.   Key words：coronary disease; plasma homocysteine; risk factors; coronary arteriog

8、raphy   高同型半胱氨酸血癥是冠心病發(fā)病的獨(dú)立危險(xiǎn)因素，已成為近年來(lái)國(guó)內(nèi)外研究的熱點(diǎn)，多個(gè)試驗(yàn)表明，HCY可通過多種機(jī)制參與動(dòng)脈粥樣硬化的發(fā)生發(fā)展，本研究即采用病例對(duì)照研究方法，探討血HCY水平與冠狀動(dòng)脈病變之間的關(guān)系，為冠心病的診斷及治療提供新方法和理論依據(jù)。   1  資料與方法   1.1  臨床資料   選擇2005年4月至2007年2月于葫蘆島市中心醫(yī)院心內(nèi)科住院并進(jìn)行冠狀動(dòng)脈造影的患者132例，其中男性105例，平均年齡（59.3±11.29）歲。女性27例，平均年齡

9、(59.92±8.37)歲。排除了風(fēng)濕性心臟病，各種急慢性炎癥，嚴(yán)重肝腎功能不全，腦血管外周血管疾病，服用維生素藥物，雌激素缺乏疾病等情況。根據(jù)冠脈造影結(jié)果分為非冠心病組（無(wú)狹窄或狹窄50%）：25例；單支病變組：35例；雙支病變組：35例；三支病變組：37例。   1.2  研究方法            2  結(jié)   果   *多組間均數(shù)比較，P0.05；#非冠心病組與單之病變組均數(shù)比較，P0.05；單

10、支病變組與雙支病變組均數(shù)比較，P0.05；雙支病變組與三支病變組均數(shù)比較，P0.05   3  討   論   冠心病是威脅人類健康且發(fā)病率較高的疾病，在對(duì)冠心病發(fā)病因素研究中，已證實(shí)糖尿病，高血壓，高脂血癥，吸煙，肥胖等為其獨(dú)立危險(xiǎn)因素，但仍有部分冠心病者缺乏此危險(xiǎn)因素，同時(shí)發(fā)現(xiàn)部分患者血同型半胱氨酸水平升高。近年研究表明，HCY可通過多種機(jī)制參與冠心病的發(fā)生發(fā)展，McCully等2-4發(fā)展了動(dòng)脈粥樣硬化的HCY理論，即冠狀動(dòng)脈，腦動(dòng)脈及周圍血管粥樣硬化患者血中HCY濃度均升高。并認(rèn)為不僅血漿中HCY濃度重度升高，且中度甚

11、至輕度升高均與動(dòng)脈粥樣硬化性心臟病發(fā)病有關(guān)。Bouskey5通過對(duì)27個(gè)研究結(jié)果進(jìn)行綜合分析，計(jì)算出血漿HCY每升高5 mmol/L，患冠心病的危險(xiǎn)性，男性增加1.6倍。女性增加1.8倍，相當(dāng)于總膽固醇每升高0.52 mmol/L的危險(xiǎn)性。   冠狀動(dòng)脈粥樣硬化造成冠狀動(dòng)脈管腔狹窄是冠心病心肌缺血的重要病理生理基礎(chǔ)，冠狀動(dòng)脈病變程度是反映病情輕重的指標(biāo)之一。Mayer等通過血管內(nèi)超聲觀察冠狀動(dòng)脈內(nèi)粥樣斑塊情況，發(fā)現(xiàn)HCY濃度大于8 mol/L冠狀動(dòng)脈內(nèi)粥樣斑塊明顯增大（0.271.04）mm。表明HCY與冠狀動(dòng)脈病變程度呈正相關(guān)。Verhacf發(fā)現(xiàn)血漿HCY水平與冠狀動(dòng)脈堵

12、塞支數(shù)呈線性相關(guān)，也與冠狀動(dòng)脈硬化程度正相關(guān)，本研究結(jié)果與之相仿：隨病變支數(shù)的增加HCY水平逐漸增高，示HCY水平可作為判定冠狀動(dòng)脈病變嚴(yán)重及復(fù)雜程度的指標(biāo)。【參考文獻(xiàn)】  1 吳慶.心肌標(biāo)志物的研究進(jìn)展及臨床應(yīng)用.國(guó)外醫(yī)學(xué).臨床生物化學(xué)與檢驗(yàn)學(xué)分冊(cè)，2003，24(6):359-360.2 Boers GHJ，Smais AGH，Trijbels FJM，et al.Heterzygosity for homocystinuria in premature peripheral and cerebral occtysive arterial diseaseJ. N Engl J M

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14、 in US physicinsJ. JAMA，1992，268(7):877.5 Boushey CJ，Beresford SA，Omenn GS，et al.A qusntitative assessment of plasma homocysteine as a risk factor for vascular disease; probble benefits of increasing folic acid intakeJ.JAMA，1995，274(13):1049.6 Mayer EL，Robinson K，Jacobsen DW，et al.Low plasma homocysteine levels predict reduced atheroma burden in patients undergoing coronary interventions:Evidence from intravas