| 杨 蓉,但慧敏,孙家安,鲁雅楠,邵会雨,刘 裴.血清同型半胱氨酸水平对急性ST段抬高型心肌梗死PCI术后患者左心室重构、心肌灌注和预后的影响[J].,2021,(11):2148-2152 |
| 血清同型半胱氨酸水平对急性ST段抬高型心肌梗死PCI术后患者左心室重构、心肌灌注和预后的影响 |
| Effects of Serum Homocysteine Level on Left Ventricular Remodeling, Myocardial Perfusion and Prognosis in Patients with Acute ST-segment Elevation Myocardial Infarction after PCI |
| 投稿时间：2021-01-06 修订日期：2021-01-28 |
| DOI：10.13241/j.cnki.pmb.2021.11.033 |
| 中文关键词: 同型半胱氨酸 急性ST段抬高型心肌梗死 经皮冠状动脉介入 左心室重构 心肌灌注 预后 |
| 英文关键词: Homocysteine Acute ST-segment elevation myocardial infarction Percutaneous coronary intervention Ventricular remodeling Myocardial perfusion Prognosis |
| 基金项目:河北省卫计委重点科技研究计划项目（20190557） |
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| 摘要 目的：探讨血清同型半胱氨酸（Hcy）水平与急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后左心室重构、心肌灌注以及预后的关系。方法：选择2018年2月至2020年1月我院收治的70例STEMI患者，根据入院时血清Hcy水平分为高水平Hcy组（Hcy＞30 μmol/L，41例）和低水平Hcy组（15≤Hcy≤30 μmol/L，29例）。PCI术后1个月、6个月、12个月检测左室重量指数(LVMI)和左心室射血分数(LVEF)，复查冠脉造影，评价TIMI心肌灌注分级（TMPG）。Pearson相关或Spearman秩相关性分析Hcy水平与LVMI、LVEF、TMPG分级相关性。所有患者PCI术后随访12个月，记录患者随访期间全因死亡和主要不良心脏事件（MACE）发生情况。Cox风险比例回归分析PCI术后STEMI患者预后的影响因素。结果：高水平Hcy组PCI术后6、12个月 LVEF低于低水平Hcy组（P＜0.05），LVMI高于低水平Hcy组（P＜0.05），高水平Hcy组PCI术后心肌灌注不良发生率高于低水平Hcy组（P＜0.05）。Hcy水平与PCI术后6、12个月 LVEF呈负相关（P＜0.05），与LVMI呈正相关（P＜0.05），与PCI术后TMPG分级呈负相关（P＜0.05）。高水平Hcy组随访期间全因死亡和MACE发生率均高于低水平Hcy组（P＜0.05）。Cox风险比例回归分析结果显示Hcy、术前Gensini评分是STEMI患者PCI术后预后不良的影响因素（P＜0.05）。结论：高水平Hcy与STEMI患者PCI术后左心室重构、心肌灌注有关，且Hcy是STEMI患者PCI术后发生全因死亡和MACE的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between serum homocysteine (Hcy) level and left ventricular remodeling, myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods: A total of 70 patients with STEMI who were admitted to our hospital from February 2018 to January 2020 were selected, and they were divided into high level Hcy group (Hcy > 30 μmol/L, 41 cases) and low level Hcy group (15≤Hcy≤30μmol/L, 29 cases) according to the serum Hcy level at admission. Left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) were measured at 1 month, 6 months and 12 months after PCI, coronary angiography was reviewed, and TIMI myocardial perfusion grade (TMPG) was evaluated. Pearson correlation or Spearman rank correlation analysis were used to analyze the correlation between Hcy level and LVMI, LVEF and TMPG grades. All patients were followed up for 12 months after PCI, all-cause deaths and major adverse cardiac events (MACE) were recorded during follow-up. Cox risk ratio regression was used to analyze the prognostic factors of patients with STEMI after PCI. Results: LVEF of the high level Hcy group at 3 and 12 months after PCI was lower than that of the low level Hcy group (P < 0.05), and LVMI was higher than that of the low level Hcy group (P < 0.05). The incidence rate of poor myocardial perfusion after PCI in the high level Hcy group was higher than that in the low level Hcy group (P< 0.05). Hcy level was negatively correlated with LVEF at 3 and 12 months after PCI (P < 0.05), positively correlated with LVMI (P < 0.05), and negatively correlated with TMPG grade after PCI (P < 0.05). The incidence rate of all-cause death and MACE during follow-up in the high level Hcy group were higher than those in the low level Hcy group (P < 0.05). Cox proportional risk regression analysis showed that Hcy and preoperative Gensini score were were influential factors for poor prognosis in patients with STEMI after PCI (P< 0.05). Conclusion: High Hcy level is associated with left ventricular remodeling and myocardial perfusion in patients with STEMI after PCI, and Hcy is an influential factor for all-cause death and MACE in patients with STEMI after PCI. |
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