高尿酸血症及高同型半胱氨酸血症干预治疗对急性心肌梗死患者预后的影响
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摘要
目的探讨高尿酸血症及高同型半胱氨酸血症干预治疗对急性心肌梗死患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后血生化指标及预后的影响。方法行PCI术的150例急性心肌梗死并高尿酸血症及高同型半胱氨酸血症患者,根据是否给予高尿酸及高同型半胱氨酸血症干预治疗分为干预组70例和非干预组80例,Pearson法分析PCI术前Syntax积分与血清尿酸、同型半胱氨酸、总胆红素、C反应蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平的相关性;PCI术后1个月,比较2组上述指标变化及主要不良心、脑血管事件发生率。结果 PCI术前Syntax积分与血清尿酸(r=0.897,P<0.001)、同型半胱氨酸(r=0.836,P<0.001)、C反应蛋白(r=0.269,P=0.038)、总胆固醇(r=0.654,P<0.001)、三酰甘油(r=0.631,P<0.001)、低密度脂蛋白胆固醇(r=0.620,P<0.001)呈正相关,与总胆红素(r=-0.278,P=0.036)、高密度脂蛋白胆固醇(r=-0.664,P<0.001)呈负相关;PCI术后1个月,干预组血清尿酸[(450.67±34.47)μmol/L]、同型半胱氨酸[(10.39±0.14)μmol/L]、C反应蛋白[(3.20±0.21)mg/L]、总胆固醇[(2.13±0.54)mmol/L]、三酰甘油[(1.44±0.17)mmol/L]、低密度脂蛋白胆固醇[(1.81±0.21)mmol/L]水平低于非干预组[(500.77±44.11)μmol/L、(13.54±0.94)μmol/L、(6.20±0.31)mg/L、(3.21±0.68)mmol/L、(3.45±0.56)mmol/L、(2.19±0.15)mmol/L](P<0.05),总胆红素[(15.22±1.11)μmol/L]、高密度脂蛋白胆固醇[(1.12±0.12)mmol/L]高于非干预组[(12.43±1.99)μmol/L、(0.88±0.04)mmol/L](P<0.05);干预组主要不良心、脑血管事件发生率(2.86%)低于非干预组(11.25%)(P<0.05)。结论高尿酸及高同型半胱氨酸血症干预治疗可影响急性心肌梗死患者PCI术后血生化指标,降低主要不良心、脑血管事件发生率。
Objective To study the influence of the interventional therapy of hyperuricemia and hyperhomocysteine on the level of biochemical indicators and prognosis of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI). Methods Totally 150 AMI patients complicated with hyperuricemia and hyperhomocystinemia after PCI were divided into intervention group(n=70)and non-intervention group(n=80).The correlations of Syntax score with uric acid(UA),homocysteine(Hcy),total bilirubin(TBiL),C-reactive protein(CRP),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were analyzed in two groups.The changes of the above indexes and the incidences of major adverse cardiovascular and cerebral events(MACCEs)were compared one month after PCI between two groups.Results Syntax score was positively correlated with UA(r=0.897,P<0.001),Hcy(r=0.836,P<0.001),CRP(r=0.269,P=0.038),TC(r=0.654,P<0.001),TG(r=0.631,P<0.001)and LDL-C(r=0.620,P<0.001),and negatively correlated with TBiL(r=-0.278,P=0.036)and HDL-C(r=-0.664,P<0.001).After PCI,the levels of UA((450.67±34.47)μmol/L),Hcy((10.39±0.14)μmol/L),CRP((3.20±0.21)mg/L),TC((2.13±0.54)mmol/L),TG((1.44±0.17)mmol/L)and LDL-C((1.81±0.21)mmol/L),as well as the incidence of MACCEs(2.86%)in intervention group were significantly lower than those in non-intervention group((500.77±44.11)μmol/L,(13.54±0.94)μmol/L,(6.20±0.31)mg/L,(3.21±0.68)mmol/L,(3.45±0.56)mmol/L,(2.19±0.15)mmol/L,11.25%)(P<0.05),while the levels of TBiL((15.22±1.11)μmol/L)and HDL-C((1.12±0.12)mmol/L)in intervention group were significantly higher than those in non-intervention group((12.43±1.99)μmol/L,(0.88±0.04)mmol/L)(P<0.05).Conclusion The interventional therapy of hyperuricemia and hyperhomocystinemia can improve the biochemical indicators and reduce the incidence of MACCEs.
Objective To study the influence of the interventional therapy of hyperuricemia and hyperhomocysteine on the level of biochemical indicators and prognosis of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI). Methods Totally 150 AMI patients complicated with hyperuricemia and hyperhomocystinemia after PCI were divided into intervention group(n=70)and non-intervention group(n=80).The correlations of Syntax score with uric acid(UA),homocysteine(Hcy),total bilirubin(TBiL),C-reactive protein(CRP),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were analyzed in two groups.The changes of the above indexes and the incidences of major adverse cardiovascular and cerebral events(MACCEs)were compared one month after PCI between two groups.Results Syntax score was positively correlated with UA(r=0.897,P<0.001),Hcy(r=0.836,P<0.001),CRP(r=0.269,P=0.038),TC(r=0.654,P<0.001),TG(r=0.631,P<0.001)and LDL-C(r=0.620,P<0.001),and negatively correlated with TBiL(r=-0.278,P=0.036)and HDL-C(r=-0.664,P<0.001).After PCI,the levels of UA((450.67±34.47)μmol/L),Hcy((10.39±0.14)μmol/L),CRP((3.20±0.21)mg/L),TC((2.13±0.54)mmol/L),TG((1.44±0.17)mmol/L)and LDL-C((1.81±0.21)mmol/L),as well as the incidence of MACCEs(2.86%)in intervention group were significantly lower than those in non-intervention group((500.77±44.11)μmol/L,(13.54±0.94)μmol/L,(6.20±0.31)mg/L,(3.21±0.68)mmol/L,(3.45±0.56)mmol/L,(2.19±0.15)mmol/L,11.25%)(P<0.05),while the levels of TBiL((15.22±1.11)μmol/L)and HDL-C((1.12±0.12)mmol/L)in intervention group were significantly higher than those in non-intervention group((12.43±1.99)μmol/L,(0.88±0.04)mmol/L)(P<0.05).Conclusion The interventional therapy of hyperuricemia and hyperhomocystinemia can improve the biochemical indicators and reduce the incidence of MACCEs.
引文
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[5]方莉娜.促炎-抗炎平衡在冠心病中作用研究进展[J].中华实用诊断与治疗杂志,2017,31(4):394-396.
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[7]KAYACELEBI A A,WILLERS J,PHAM V V,et al.Plasma homoarginine,arginine,asymmetric dimethylarginine and total homocysteine interrelationships in rheumatoid arthritis,coronary artery disease and peripheral artery occlusion disease[J].Amino Acids,2015,47(9):1885-1891.
[8]王丽娟,樊华,白宏兴.降同型半胱氨酸疗法对冠心病介入治疗后患者炎性因子水平的影响[J].中国循证心血管医学杂志,2017,9(1):78-80.
[9]刘英,白晟遥,高辉,等.降同型半胱氨酸疗法对冠心病介入治疗后患者的疗效[J].心血管康复医学杂志,2015,24(6):640-643.
[2]姚艳妮,胡越成,丛洪良.Syntax评分及其衍生评分的研究进展[J].中华心血管病杂志,2017,45(4):341-344.
[3]FROMONOT J,DEHARO P,BRUZZESE L,et al.Adenosine plasma level correlates with homocysteine and uric acid concentrations in patients with coronary artery disease[J].Can JPhysiol Pharmacol,2016,94(3):272-276.
[4]苏恩勇,高传玉.内皮功能障碍与心血管疾病关系的研究进展[J].中华实用诊断与治疗杂志,2018,32(6):622-624.
[5]方莉娜.促炎-抗炎平衡在冠心病中作用研究进展[J].中华实用诊断与治疗杂志,2017,31(4):394-396.
[6]HAN L,WU Q,WANG C,et al.Homocysteine,ischemic stroke,and coronary heart disease in hypertensive patients a population based,prospective cohort study[J].Stroke,2015,46(7):1777-1786.
[7]KAYACELEBI A A,WILLERS J,PHAM V V,et al.Plasma homoarginine,arginine,asymmetric dimethylarginine and total homocysteine interrelationships in rheumatoid arthritis,coronary artery disease and peripheral artery occlusion disease[J].Amino Acids,2015,47(9):1885-1891.
[8]王丽娟,樊华,白宏兴.降同型半胱氨酸疗法对冠心病介入治疗后患者炎性因子水平的影响[J].中国循证心血管医学杂志,2017,9(1):78-80.
[9]刘英,白晟遥,高辉,等.降同型半胱氨酸疗法对冠心病介入治疗后患者的疗效[J].心血管康复医学杂志,2015,24(6):640-643.