急性非ST段抬高型心肌梗死患者血清同型半胱氨酸水平与SYNTAX评分的关系

doi:10.3969/j.issn.1004-583X.2022.04.007

摘要/Abstract

摘要：

目的探讨急性非ST段抬高型心肌梗死(NSTEMI)患者血清同型半胱氨酸水平与STNTAX评分(SS)之间的关系。方法对298例NSTEMI患者进行回顾性分析,对患者总体特征、包括血清同型半胱氨酸水平(HCY)在内的多项化验指标和在院期间超声左心室射血分数等辅助检查结果以及冠状动脉造影后所计算的SS进行统计及分析。依据计算出的SS将入选患者分为3组,低SS组:SS≤22;中等SS组:22<SS<33;高SS组:SS≥33,分析并比较3组相关数据。结果入组的298例NSTEMI患者包括低SS组177例(59.4%),中等SS组77例(25.8%),高SS组44例(14.8%)。血清HCY水平在低SS组为(16.1±9.1) μmol/L,中等SS组为(20.3±9.1) μmol/L,高SS组为(27.5±9.5) μmol/L。中等SS组和高SS组的HCY水平明显高于低SS组(P<0.01)。相关分析显示血清HCY水平与SS相关(r=0.358,P<0.01)。结论 NSTEMI患者的血清HCY水平与冠状动脉病变严重程度有关。

关键词: 非ST段抬高型心肌梗死, 同型半胱氨酸, SYNTAX评分

Abstract:

Objective To explore the relationship between serum homocysteine(HCY) levels and SYNTAX score(SS) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods We performed a retrospective analysis of 298 patients with NSTEMI from the aspects of general clinical features, multiple laboratory indicators including serum HCY level, left ventricular ejection fraction (LVEF) and SS on the echocardiography during hospitalization. SS was also calculated according to the images of angiography for further statistical analysis. The patients were divided into three groups according to the SS value: low- (SS≤22), medium- (22<SS<33),high-SS group(SS≥33), with a comparison of interclass correlation from related data. Results The enrolled 298 NSTEMI patients consisted of 177 patients (59.4%) in the low-SS group, 77 (25.8%) in the medium-SS group, and 44 (14.8%) in the high-SS group. Serum HCY levels were (16.1±9.1) μmol/L, (20.3±9.1) μmol/L, (27.5±9.5) μmol/L in low-, medium-, and high-SS groups, respectively. Serum HCY levels in medium-, high-SS groups were significantly higher than those in low-SS group (P<0.01). The related analysis indicated homocysteine levels were correlated with SS (r=0.358, P<0.01). Conclusion Serum HCY levels were associated with increasing severity of coronary artery disease in the patients with NSTEMI.

Key words: non-ST-segment elevation myocardial infarction, homocysteine, SYNTAX score

中图分类号:

R541.4

王雅洁, 林文华, 敬锐, 刘菁晶, 卢宇杰. 急性非ST段抬高型心肌梗死患者血清同型半胱氨酸水平与SYNTAX评分的关系[J]. 临床荟萃, 2022, 37(4): 325-328.

Wang Yajie, Lin Wenhua, Jing Rui, Liu Jingjing, Lu Yujie. The relationship between serum homocysteine levels and SYNTAX score in patients with non-ST-segment elevation myocardial infarction[J]. Clinical Focus, 2022, 37(4): 325-328.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.04.007

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I4/325

图/表 4

参考文献 19

[1]	Antoniades C, Antonopoulos AS, Tousoulis D. et al. Homocysteine and coronary atherosclerosis: From folate fortification to the recent clinical trials[J]. Eur Heart J, 2009, 30(1): 6-15. doi: 10.1093/eurheartj/ehn515 URL
[2]	Smith SC Jr. Current and future directions of cardiovascular risk prediction[J]. Am J Cardiol, 2006, 97(2a): 28a-32a.
[3]	Miao L, Deng GX, Yin RX. et al. No causal effects of plasma homocysteine levels on the risk of coronary heart disease or acute myocardial infarction: A Mendelian randomization study[J]. Eur J Prev Cardiol, 2021, 28(2): 227-234. doi: 10.1177/2047487319894679
[4]	Wu HY, Gao TJ, Cao YW. et al. Analysis of the association and predictive value of hyperhomocysteinaemia for obstructive coronary artery disease[J]. J Int Med Res, 2021, 49(7): 3000605211033495.
[5]	Shih CC, Shih YL, Chen JY. The association between homocysteine levels and cardiovascular disease risk among middle-aged and elderly adults in Taiwan[J]. BMC Cardiovasc Disord, 2021, 21(1): 191. doi: 10.1186/s12872-021-02000-x URL
[6]	Muzaffar R, Khan MA, Mushtaq MH. et al. Hyperhomocysteinemia as an independent risk factor for coronary heart disease. Comparison with conventional risk factors[J]. Braz J Biol, 2021, 83: e249104.
[7]	Markovi'c-Boras M, ˇCauševi'c A, 'Curlin M. A relation of serum homocysteine and uric acid in Bosnian diabetic patients with acute myocardial infarction[J]. J Med Biochem, 2021, 40(3): 261-269. doi: 10.5937/jomb0-28391 URL
[8]	Guan J, Wu L, Xiao Q. et al. Levels and clinical significance of serum homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), vaspin, and visfatin in elderly patients with different types of coronary heart disease[J]. Ann Palliat Med, 2021, 10(5): 5679-5686. doi: 10.21037/apm-21-1001 URL
[9]	Yadav M, Palmerini T, Caixeta A. et al. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery[J]. J Am Coll Cardiol, 2013, 62(14): 1219-1230. doi: 10.1016/j.jacc.2013.06.047 URL
[10]	Collet JP, Thiele H, Barbato E. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J]. Eur Heart J, 2021, 42(14): 1289-1367. doi: 10.1093/eurheartj/ehaa575 URL
[11]	Shenoy V, Mehendale V, Prabhu K. et al. Correlation of serum homocysteine levels with the severity of coronary artery disease[J]. Indian J Clin Biochem, 2014, 29(3): 339-344. doi: 10.1007/s12291-013-0373-5 URL
[12]	Wu Y, Yang L, Zhong L. Decreased serum levels of thioredoxin in patients with coronary artery disease plus hyperhomocysteinemia is strongly associated with the disease severity[J]. Atherosclerosis, 2010, 212(1): 351-355. doi: 10.1016/j.atherosclerosis.2010.06.002 URL
[13]	Joubran R, Asmi M, Busjahn A. et al. Homocysteine levels and coronary heart disease in Syria[J]. J Cardiovasc Risk, 1998, 5(4): 257-261. pmid: 9919474
[14]	Fu Z, Qian G, Xue H. et al. Hyperhomocysteinemia is an independent predictor of long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome[J]. Clin Interv Aging, 2015, 10: 1467-1474.
[15]	Zhao Y, Zhang J. Clinical implication of homocysteine in premature acute coronary syndrome female patients: Its distribution and association with clinical characteristics and major adverse cardiovascular events risk[J]. 2021, 100(18): e25677.
[16]	Ma Y, Li L, Geng XB. et al. Correlation between hyperhomocysteinemia and outcomes of patients with acute myocardial infarction[J]. Am J Ther, 2016, 23(6): e1464-e1468. doi: 10.1097/MJT.0000000000000130 URL
[17]	Tyagi N, Sedoris KC, Steed M. et al. Mechanisms of homocysteine-induced oxidative stress[J]. Am J Physiol Heart Circ Physiol, 2005, 289(6): H2649-2656. doi: 10.1152/ajpheart.00548.2005 URL
[18]	王慧清, 王琰娜, 金耀来, 等. 血浆同型半胱氨酸与冠状动脉病变的关系探讨[J]. 疑难病杂志, 2014, 13(9):888-890.
[19]	Faeh D, Chiolero A, Paccaud F. Homocysteine as a risk factor for cardiovascular disease: Should we (still) worry about?[J]. Swiss Med Wkly, 2006, 136(47-48): 745-756.

项目	低SS组	中等SS组	高SS组	统计值	P值
年龄(岁)	59.4±11.1	63.7±11.3^*	65.4±12.3^*	7.161	0.001
男性[例(%)]	130(73.4)	48(62.3)	32(72.7)	3.308	0.191
高血压[例(%)]	107(60.5)	48(62.3)	27(61.4)	0.082	0.960
糖尿病[例(%)]	65(36.7)	27(35.1)	28(63.6)^*	11.781	0.003
目前仍吸烟[例(%)]	94(53.1)	37(48.1)	23(52.3)	0.556	0.757
肌酐(μmol/L)	63.8±13.3	63.9±12.4	70.2±13.6^*	4.431	0.013
总胆固醇(mmol/L)	4.4±1.0	4.5±1.1	4.5±0.8	0.116	0.891
低密度脂蛋白胆固醇(mmol/L)	2.81±0.86	2.81±0.94	2.85±0.77	0.039	0.962
白细胞总数(×10⁹/L)	8.14±2.38	8.08±2.50	8.86±2.77	1.693	0.186
血红蛋白(g/L)	147.7±18.1	142.2±20.4^*	139.7±16.3^*	4.564	0.011
血小板计数(×10⁹/L)	231.8±62.5	222.0±52.5	217.5±50.3	1.457	0.235
HCY(μmol/L)	16.1±9.1	20.3±9.1^*	27.5±9.5^*	28.827	<0.01
LVEF(%)	63.5±6.6	62.5±6.1	60.7±7.1^*	3.254	0.040

项目	低SS组	中等SS组	高SS组	统计值	P值
年龄(岁)	59.4±11.1	63.7±11.3^*	65.4±12.3^*	7.161	0.001
男性[例(%)]	130(73.4)	48(62.3)	32(72.7)	3.308	0.191
高血压[例(%)]	107(60.5)	48(62.3)	27(61.4)	0.082	0.960
糖尿病[例(%)]	65(36.7)	27(35.1)	28(63.6)^*	11.781	0.003
目前仍吸烟[例(%)]	94(53.1)	37(48.1)	23(52.3)	0.556	0.757
肌酐(μmol/L)	63.8±13.3	63.9±12.4	70.2±13.6^*	4.431	0.013
总胆固醇(mmol/L)	4.4±1.0	4.5±1.1	4.5±0.8	0.116	0.891
低密度脂蛋白胆固醇(mmol/L)	2.81±0.86	2.81±0.94	2.85±0.77	0.039	0.962
白细胞总数(×10⁹/L)	8.14±2.38	8.08±2.50	8.86±2.77	1.693	0.186
血红蛋白(g/L)	147.7±18.1	142.2±20.4^*	139.7±16.3^*	4.564	0.011
血小板计数(×10⁹/L)	231.8±62.5	222.0±52.5	217.5±50.3	1.457	0.235
HCY(μmol/L)	16.1±9.1	20.3±9.1^*	27.5±9.5^*	28.827	<0.01
LVEF(%)	63.5±6.6	62.5±6.1	60.7±7.1^*	3.254	0.040

变量	SYNTAX评分
变量	r值	P值
年龄	0.226	<0.01
糖尿病	0.112	0.055
肌酐	0.087	0.133
血红蛋白	-0.193	0.001
同型半胱氨酸	0.358	<0.01
LVEF	-0.116	0.046

变量	SYNTAX评分
变量	r值	P值
年龄	0.226	<0.01
糖尿病	0.112	0.055
肌酐	0.087	0.133
血红蛋白	-0.193	0.001
同型半胱氨酸	0.358	<0.01
LVEF	-0.116	0.046

变量	未标准化系数		标准化系数 β	t值	P值
变量	B	标准误差	标准化系数 β	t值	P值
同型半胱氨酸	0.328	0.056	0.316	5.906	<0.01
年龄	0.202	0.048	0.224	4.192	<0.01