Effect of Hyperhomocysteinemia on Cardiac Function and Mortality of Patients with Acute Myocardial Infarction Concomitant Hypertension underwent Primary Percutaneous Coronary Intervention after 6 Months
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摘要:
目的 回顾性分析高同型半胱氨酸（homocysteine，Hcy）对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)合并高血压患者急诊行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后6个月左心功能及死亡的影响。 方法 纳入2015年6月至2016年12月期间因STEMI合并高血压在联勤保障部队第九二O医院心内科行急诊PCI的患者78例，依据Hcy水平是否≥15.0 μmol/L分为STEMI合并H型高血压组、STEMI合并单纯高血压组各39例。比较两组患者一般资料如人口学特征、合并症、术前用药情况、相关检验结果等，PCI术中及住院期间相关数据如冠脉病变情况、术中手术情况、辅助治疗以及术后用药等，术后6个月左室射血分数及累计死亡的情况。 结果 性别、血肌酐、Hcy、病变血管支数对比组间有差异，具有统计学意义（P < 0.05）。住院左心室射血分数（left ventricular ejection fractions，LVEF）、6月LVEF、两次LVEF差值以及6月累计死亡，差异均无统计学意义（P > 0.05）。 结论 高Hcy对STEMI合并高血压患者行急诊PCI术后6月心功能及累计死亡无影响。 -
关键词:
- 高同型半胱氨酸血症 /
- ST段抬高型心肌梗死 /
- 高血压 /
- 经皮冠状动脉介入治疗 /
- 心功能 /
- 死亡
Abstract:Objective To identify the effect of hyperhomocysteinemia on cardiac function and mortality in patients with acute ST-segment elevation myocardial infarction concomitant hypertension underwent primary PCI after 6 months. Methods 192 patients in the Department of Cardiology, 920th Hospital of Joint Logistics Support Force with acute ST-segment elevation myocardial infarction concomitant hypertension who had undergone primary PCI was recruited from June 2015 to December 2016. 116 cases were excluded from the study owing to their incomplete follow-up data .The total remaining 78 patients were divided into two groups according to the level of homocysteine （Hcy） ≥15.0 mol/L: STEMI combined with H-type hypertension group （n = 39） and the STEMI combined with hypertension group （n = 38）. Baseline data of the two groups, relevant data during hospitalization and PCI, and left ventricular ejection fraction and cumulative mortality 6 months after surgery were compared. Results There were statistically significant differences in male proportion, serum creatinine and HCY between the two groups （P < 0.05）. There was statistically significant difference in the number of lesion vessels which was higher in the high Hcy group than in the control group （P < 0.012）. No statistically significant difference was showed in left ventricular ejection fraction at the time of hospitalization and the 6th month, the difference value between two left ventricular ejection fractions and the cumulative death at the 6th month between the two groups （all P > 0.05）. Conclusion Hyperhomocysteine has no effect on cardiac function and cumulative mortality 6 months after primary PCI in patients with acute ST-segment elevation myocardial infarction concomitant hypertension. -
表 1 一般资料（
$\bar x \pm s$ ）Table 1. Baseline data （
$\bar x \pm s$ ）项目 STEMI合并H型高血压组（n = 39） STEMI合并单纯高血压组（n = 39） t/ z/χ2 P 年龄（岁） 59.36 ± 10.26 57.13 ± 11.49 0.904 0.369 男 [n（%）] 37(94.9) 27(69.2) 8.705 0.003 * 糖尿病[n（%）] 7(17.9) 10(25.6) 0.677 0.411 高血脂[n（%）] 5(12.8) 2(5.1) 0.628 0.428 吸烟[n（%）] 28(71.8) 22(56.4) 2.006 0.157 冠心病家族史[n（%）] 3(7.7) 6(15.4) 1.130 0.288 心绞痛史[n（%）] 13(33.3) 9(23.1) 1.013 0.314 FMC时间[min，（Q1，Q3)] 157(108，365) 245(170，350) −1.134 0.257 D-to-B时间[min，（Q1，Q3)] 38(31，50) 37(32，50) −0.005 0.996 心肌总缺血时间[min，（Q1，Q3)] 210(133，391) 276(185，393) −0.994 0.320 罪犯血管再通[n（%）] 7(17.9) 7(17.9) 0.000 1.000 术前用药情况[n（%）] 阿司匹林 38(97.4) 37(94.9) 0.353 0.552 氯吡格雷 32(82.1) 30(76.9) 0.315 0.575 替格瑞洛 5(12.8) 7(17.9) 0.394 0.530 他汀类药物 1(2.6) 2(5.1) 0.353 0.552 钙拮抗剂 8(20.5) 6(15.4) 0.348 0.555 ACEI/ARB 3(7.7) 5(12.8) 0.562 0.453 β阻滞剂 0(0.0) 2(5.1) 2.825 0.093 溶栓类药物 1(2.6) 0(0.0) 0.000 1.000 SCr [ µmol/L，（Q1，Q3)] 88(71，105) 74(64，91) −2.234 0.025* HCY [ µmol/L，（Q1，Q3)] 20.7(17.4，34) 11.6(9.3，13) −7.600 < 0.001* 尿酸[ µmol/L，（Q1，Q3)] 419.92 ± 116.93 412.46 ± 98.96 0.000 1.000 CK峰值[U/L，（Q1，Q3)] 2901(1481，4382) 2580(1772，4161) −0.315 0.753 术前血糖[mmol/L，（Q1，Q3)] 7.2(6.2，10.4) 7.8(6.6，10.1) −1.295 0.195 术前血脂[mmol/L，（Q1，Q3)] TC 5.08 ± 1.08 4.98 ± 0.96 −0.120 0.905 TG 2.15 ± 3.18 1.69 ± 1.45 −0.944 0.345 LDL 3.19 ± 1.06 3.09 ± 0.89 −0.055 0.956 HDL 1.07 ± 0.35 1.13 ± 0.32 −0.165 0.869 注： Hcy，同型半胱氨酸；FMC，首次医疗接触；D2B，入门至球囊扩张；ACEI/ARB，血管紧张素转换酶抑制药/ 血管紧张素Ⅱ受体拮抗药；SCr，血肌酐；CK，肌酸激酶；TC，总胆固醇；TG，三酰甘油；LDL-C，低密度脂蛋白胆固醇；HDL-C，高密度脂蛋白胆固醇。*P < 0.05。 
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表 2 PCI术中及住院期间相关数据[n（%）]
Table 2. Relevant data during hospitalization and PCI [n（%）]
项目 STEMI合并H型高血压组n = 39 STEMI合并单纯高血压组n = 39 t/ z/χ2 P Killip分级 0.724 0.868 Ⅰ级 4(14.8) 6(17.6) Ⅱ级 9(33.3) 13(38.2) Ⅲ级 4(14.8) 3(8.8) Ⅳ级 10(37.0) 12(35.3) 犯罪血管位置 0.740 0.864 LAD 20(51.3) 20(51.3) LCX 4(10.3) 2(5.1) LM 1(2.6) 1(2.6) RCA 14(35.9) 16(41.0) 病变血管支数 8.914 0.012* 单支 0(0.0) 6(15.4) 两支 13(33.3) 12(30.8) 多支 26(66.7) 21(53.8) 血管扩张次数(Q1，Q3) 3(2，3) 3(2，4) −1.084 0.278 支架长度[mm(Q1，Q3)] 29(20，41) 29(23，36) −0.191 0.849 支架直径[mm(Q1，Q3)] 3.08(3，3.5) 3.25(3，3.5) −0.413 0.680 术中用药情况 替罗非班 20(51.3) 21(53.8) 0.051 0.821 尼克地尔 4(10.3) 1(2.6) 2.051 0.152 肝素 39(100.0) 39(100.0) 0.000 1.000 术后TIMI 血流分级 0.513 0.474 Ⅲ级 37(94.9) 39(100.0) Ⅲ级 2(5.1) 0(0.0) 辅助治疗情况 IABP 7(17.9) 10(25.6) 0.677 0.411 临时起搏器 8(20.5) 9(23.1) 0.075 0.784 血栓抽吸 0(0.0) 1(2.6) 0.000 1.000 术后用药情况 阿司匹林 39(100.0) 39(100.0) 0.000 1.000 氯吡咯雷 31(79.5) 36(92.3) 2.646 0.104 替格瑞洛 8(20.5) 3(7.7) 2.646 0.104 他汀类药物 38(97.4) 39(100.0) 0.000 1.000 钙拮抗剂 5(12.8) 10(25.6) 2.063 0.151 ACEI/ARB 37(94.9) 38(97.4) 0.000 1.000 β阻滞剂 33(84.6) 34(87.2) 0.106 0.745 替罗非班 33(84.6) 31(79.5) 0.348 0.555 尼可地尔 4(10.3) 5(12.8) 0.126 0.723 肝素 37(94.9) 39(100.0) 2.825 0.093 住院LVEF （%，$\bar x \pm s$） 0.46 ± 0.05 0.47 ± 0.06 −0.575 0.565 注：LAD，左前降支；RCA，右冠状动脉；LCX，左回旋支；LM，左主干；IABP，主动脉内球囊反搏；ACEI/ARB，血管紧张素转换酶抑制药/ 血管紧张素Ⅱ受体拮抗药；LVEF，左心室射血分数。*P < 0.05。
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表 3 术后心功能及累计死亡情况比较（
$\bar x \pm s$ ）Table 3. Comparison of postoperative cardiac function and cumulative mortality （
$\bar x \pm s$ ）项目 STEMI合并H型高血压组（n = 39） STEMI合并单纯高血压组（n = 39） t/ χ2 P 住院LVEF(%) 46.35 ± 5.2 46.95 ± 5.97 −0.471 0.639 6月LVEF(%) 46.13 ± 4.68 48.56 ± 6.05 −1.974 0.052 LVEF差值(%) −0.49 ± 6.61 1.61 ± 4.25 −1.658 0.102 6月累计死亡率[n(%)] 8(21.05) 5(13.16) 0.835 0.361 注：LVEF：左心室射血分数。
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