血浆高半胱氨酸对冠心病、脑卒中临床预后的影响

Homocysteine on the prognosis of coronary artery heart disease and stroke

摘要:

目的 探讨高半胱氨酸（Hcy）对冠心病和脑卒中临床预后的影响。方法 234例冠心病、脑卒中患者随机分为对照组和叶酸治疗组。对照组给予降血压、降血脂、降血糖及抗血小板聚集等综合治疗; 叶酸治疗组在对照组治疗的基础上加服叶酸片10 mg, 1次/d。2组疗程均为1年。观察2组治疗前、治疗后6, 12个月血浆Hcy水平的变化及治疗后6, 12个月冠心病临床事件（急性左心衰竭、急性心肌梗死、猝死、心绞痛发作、心律失常）、脑卒中临床事件（脑梗死、短暂脑缺血发作或可逆性缺血性损伤、脑出血）发病情况, 研究其与血浆Hcy水平变化的相关性。结果 叶酸治疗组治疗前、治疗后6个月血浆Hcy水平与对照组比较差异均无统计学意义（P＞0.05）, 而治疗后12个月血浆Hcy水平明显低于对照组（P＜0.05）。对照组和叶酸治疗组治疗后12个月临床事件发生率分别为26.92%和11.02%, 2组比较差异有统计学意义（P＜0.05）。Logistic多元回归分析结果显示, 冠心病、脑卒中临床事件发生与糖尿病、高Hcy血症相关（P＜0.05, P＜0.01）; 高Hcy血症是冠心病、脑卒中临床事件发生的危险因素。结论 高Hcy血症与冠心病、脑卒中临床事件发生明显相关; 口服叶酸片能显著降低血浆Hcy水平, 减少冠心病、脑卒中临床事件发生率, 在二级预防中具有重要意义。

Abstract:

Objective To explore the effect of homocysteine(Hcy) on the prognosis of coronary artery heart disease(CHD) and stroke. Methods Totally 234 patients with CHD or stroke were divided into control group and folic acid-therapy group randomly. Patients in control group were comprehensively treated with antihypertensive, lipid-adjusting, hypoglycemic and anti-platelet aggregation drugs, while patients in folic acid-therapy group were given oral folic acid tablets(10 mg per day) besides above treatment. Period of treatment was one year and patients were all followed up. Plasma Hcy levels were measured prior treatment, 6 months and 12 months post treatment and the incidences of clinical event with coronary artery heart disease(acute left heart failure, acute myocardial infarction, sudden cardiac death, angina pectoris attack and arrhythmia) and stroke(apoplexy, transient ischemic attack or reversible ischemic injury, cerebral hemorrhage) were also monitored. Results There was no significant difference in plasma, Hcy between control group and folic acid-therapy group at prior treatment and 6 months post treatment(P＞0.05). However, 12 months after treatment plasma, Hcy level in folic acid-therapy group was significantly lower than that in control group(P＜0.05). The incidences of clinical event with CHD and stroke were 11.02% and 26.92% respectively in control and olic acid-therapy group 12 months after treatment (P＜0.05). Logistic regression analysis showed that the incidences of clinical event with CHD and stroke were related with diabetes mellitus and Hcy (P＜0.05, P＜0.01); moreover, Hcy was a risk factor of CHD and Stroke. Conclusion Hcy is significantly correlated to clinical event with CHD and stroke; oral administration of folic acid can significantly decrease the incidence of clinical event with CHD and stroke through reducing plasma Hcy level and has great function in the secondary prevention of CHD and stroke.