Analysis in prognosis of acute myocardial infarction patients complicated with hyperhomocysteinemia undergoing elective percutaneous coronary intervention
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摘要:目的
探讨微循环阻力指数(IMR)评估急性心肌梗死(AMI)合并高同型半胱氨酸血症(HHcy)患者短期预后的价值。
方法选取因AMI行择期经皮冠状动脉介入治疗(PCI)的患者共80例。根据PCI前血浆同型半胱氨酸(Hcy)水平, 将80例患者分为HHcy组32例(Hcy≥10 μmol/L)和对照组48例(Hcy < 10 μmol/L)。比较2组患者冠状动脉造影特征、梗死相关血管IMR、PCI实施前后左心室舒张末期内径(LVEDd)和左心室射血分数(LVEF)以及主要不良心血管事件(MACE)发生率。
结果HHcy组的血浆Hcy水平、超敏C反应蛋白(hs-CRP)水平、IMR、LVEDd高于对照组, LVEF低于对照组, 差异均有统计学意义(P < 0.01)。HHcy组PCI后1 d至3个月的LVEDd差值高于对照组, LVEF差值低于对照组, 差异均有统计学意义(P < 0.01)。PCI后3个月, HHcy组的MACE发生率高于对照组, 差异有统计学意义(P < 0.05)。Logistic回归分析显示, Hcy、LVEF和年龄是AMI患者PCI后3个月发生MACE的独立危险因素(r=0.335、0.396、0.317, OR=3.756、5.016、2.702)。Hcy水平与IMR (r=0.524, P < 0.001)、LVEDd (r=0.430, P=0.003)呈正相关, 与LVEF (r=-0.544, P < 0.001)呈负相关。
结论HHcy与IMR和心功能不全的严重程度呈正相关, 同时也是AMI患者选择性PCI后发生MACE的重要因素。
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关键词:
- 急性心肌梗死 /
- 高同型半胱氨酸血症 /
- 经皮冠状动脉介入治疗 /
- 冠状动脉微循环阻力 /
- 预后因素
Abstract:ObjectiveTo investigate the value of microcirculation resistance index (IMR) in evaluating the short-term prognosis of acute myocardial infarction (AMI) patients complicated with hyperhomocysteinemia (HHcy).
MethodsA total of 80 patients with elective percutaneous coronary intervention (PCI) for AMI were selected.According to the plasma homocysteine (Hcy) level before PCI, these 80 patients were divided into HHcy group with 32 cases (Hcy≥10 μmol/L) and control group with 48 cases (Hcy < 10 μmol/L).The characteristics of coronary angiography, IMR of infarction-related vessels, left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) before and after implementation of PCI, and the incidence of major adverse cardiovascular events (MACE) were compared between the two groups.
ResultsThe levels of plasma Hcy, high-sensitivity C-reactive protein (hs-CRP), IMR and LVEDd in the HHcy group were significantly higher than those in the control group, while LVEF was significantly lower than that in the control group (P < 0.01).The difference value of LVEDd from 1 day to 3 months after PCI in the HHcy group was significantly higher than that in the control group, while the LVEF difference value was significantly lower than that in the control group (P < 0.01).Three months after PCI, the incidence of MACE in the HHcy group was significantly higher than that in the control group (P < 0.05).Logistic regression analysis showed that Hcy, LVEF and age were the independent risk factors for incidence of MACE at 3 months after PCI (r=0.335, 0.396, 0.317, OR=3.756, 5.016, 2.702).Hcy level was positively correlated with IMR (r=0.524, P < 0.001) and LVEDd (r=0.430, P=0.003), and negatively correlated with LVEF (r=-0.544, P < 0.001).
ConclusionHHcy is positively correlated with the IMR and severity of cardiac insufficiency, and it is also an important factor for incidence of MACE after elective PCI in patients with AMI.
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表 1 2组患者人口学资料及临床特征比较(x±s)[n(%)]
特征 HHcy组(n=32) 对照组(n=48) χ2/t P 年龄/岁 56.4±9.8 55.3±8.7 0.643 0.482 男性 19(59.4) 25(52.1) 0.412 0.520 体质量指数/(kg/m2) 27.1±2.8 26.7±3.5 0.412 0.711 慢性肾病* 4(12.5) 4(8.3) — 0.475 吸烟 15(46.8) 16(33.3) 1.483 0.223 高血压 13(40.6) 18(37.5) 0.079 0.779 糖尿病 12(37.5) 16(33.3) 0.147 0.702 血脂异常 15(46.8) 22(45.8) 0.008 0.927 经皮冠状动脉介入治疗史 10(31.3) 18(37.5) 0.330 0.566 急性ST段抬高型心肌梗死* 29(90.6) 45(93.8) — 0.554 超敏C反应蛋白/(mg/L) 11.3±1.3 9.7±1.6 4.816 0.001 β受体阻断药 23(71.9) 35(72.9) 0.010 0.918 钙通道阻滞剂 15(46.8) 20(41.7) 0.212 0.645 阿司匹林 32(100.0) 48(100.0) — 1.000 氯吡格雷 32(100.0) 48(100.0) — 1.000 阿托伐他汀 31(96.9) 47(97.9) — 0.717 ACEI/ARB 19(59.4) 30(62.5) 0.079 0.779 同型半胱氨酸/(μmol/L) 14.1±3.3 6.6±1.6 14.284 < 0.001 ACEI/ARB: 血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂。*表示该指标采用Fisher′s精确检验。 
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表 2 2组冠状动脉造影特征及微循环阻力指数的比较(x±s)[n(%)]
指标 HHcy组(n=32) 对照组(n=48) χ2/t P 冠状动脉病变数量 1支 19(59.4) 23(47.9) 1.011 0.315 2支 11(34.3) 21(43.8) 0.703 0.402 3支* 2(6.3) 4(8.3) — 0.914 心肌梗死溶栓治疗血流分级* 2级 2(6.3) 2(4.2) — 0.727 3级 30(93.7) 46(95.8) — 0.727 冠状动脉内分布 左主干冠状动脉* 1(3.1) 0 — 0.301 左前降支 22(68.8) 32(66.7) 0.115 0.734 回旋分支* 4(12.5) 5(10.4) — 0.884 右冠状动脉 5(15.6) 11(22.9) 0.559 0.455 微循环阻力指数 38.3±8.1 27.1±4.8 8.402 < 0.001 *表示该指标采用Fisher′s精确检验。
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表 3 2组患者PCI后心功能指标及主要不良心血管事件发生率比较(x±s)
指标 时点 HHcy组(n=32) 对照组(n=48) χ2/t P 左心室舒张末期内径/mm PCI后1 d 48.2±3.7 47.3±4.6 0.989 0.325 PCI后3个月 52.3±4.2 48.4±4.6 5.410 < 0.001 变化差值 4.2±2.0 1.1±2.5 6.780 < 0.001 左心室射血分数/% PCI后1 d 50.0±7.4 52.1±6.8 1.485 0.142 PCI后3个月 47.8±6.4 54.7±6.1 5.564 < 0.001 变化差值 2.2±2.8 2.6±2.9 8.592 < 0.001 主要不良心血管事件* — 8(25.0) 3(6.3) — 0.021 PCI: 经皮冠状动脉介入治疗。*表示该指标采用Fisher′s精确检验。
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表 4 PCI后3个月MACE危险因素分析(x±s)[n(%)]
因素 单变量回归分析 Logistic回归分析 MACE组(n=11) 非MACE组(n=69) χ2/t P B r OR P 年龄/岁 57.5±9.6 52.0±10.8 0.996 0.041 0.769 0.317 2.702 0.031 男性* 7(63.6) 37(53.6) — 0.375 吸烟 5(45.5) 26(37.7) 0.373 0.542 高血压 6(54.5) 25(36.2) 1.314 0.252 糖尿病* 4(36.4) 24(34.8) — 0.979 血脂异常 5(45.5) 32(46.4) 0.041 0.839 慢性肾病* 1(9.1) 7(10.1) — 0.596 PCI史 6(54.5) 22(31.9) 2.938 0.085 钙通道阻滞剂 6(54.5) 29(42.0) 0.840 0.358 β受体阻断药* 7(63.6) 51(73.9) — 0.766 ACEI/ARB* 7(63.6) 42(60.9) — 0.512 阿托伐他汀* 10(90.9) 68(98.6) — 0.148 LVEF/% 42.9±5.0 52.5±6.5 5.637 < 0.01 0.986 0.396 5.016 0.022 Hcy/(μmol/L) 15.3±4.9 9.7±3.9 -5.458 < 0.01 0.805 0.335 3.756 0.029 PCI: 经皮冠状动脉介入治疗; ACEI/ARB: 血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂; LVEF: 左心室射血分数;
Hcy: 同型半胱氨酸; MACE: 主要不良心血管事件。*表示该指标采用Fisher′s精确检验。
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