摘要目的 探讨血清同型半胱氨酸(Hcy)水平、血尿酸水平(UA)与冠状动脉病变严重程度的关系.方法 回顾性分析2015年1月至2015年12月在北京安贞医院住院行冠状动脉造影检查者622例.根据造影结果,以任何冠脉狭窄≥50％,作为冠心病的诊断标准,分为冠脉正常组和冠心病组,并根据SYNTAX评分,将冠心病组分为低危组(1～22分)、中危组(23～32分)及高危组(＞ 33分).测定血清同型半胱氨酸水平、血尿酸水平、空腹血脂包括:总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C).比较各组患者血脂、血清同型半胱氨酸水平、血尿酸水平.以血清同型半胱氨≤15 μmol/L为正常值,再将患者分为高Hcy组和正常组,比较两组SYNTAX评分,并进行相关性分析.血尿酸男性以＜416 μmol/L为正常值,女性以＜357 μmol/L为正常值,将UA和SYNTAX评分进行相关性分析.结果 SYNTAX评分高危组、中危组与正常组比较TC、LDL-C显著增高,而正常组、低危组间差异无统计学意义(P＞0.05).SYNTAX评分高危组、中危组与冠脉正常组比较,同型半胱氨酸水平显著增高.正常Hcy组与高Hcy组在年龄、性别、TC、TG、HDL-C、LDL-C的差异无统计学意义(P＞0.05).高Hcy组患者的冠脉SYNTAX评分显著高于正常组(P＜0.05).多元Logistic回归分析表明血Hcy水平与冠脉病变程度相关(P＜0.05).SYNTAX评分高危组、中危组与同性别冠状动脉正常组比较,UA水平显著增高(P＜0.05).多元Logistic回归分析表明血UA水平与冠状动脉病变程度相关(P＜0.05).结论 血Hcy水平、血UA水平是冠脉病变严重程度的危险因素,血Hcy水平及血UA水平较高的患者冠状动脉病变程度较重.

abstractsObjective To evaluate the correlation between serum homocysteine (Hcy) level,serum uric acid level and coronary lesion severity in patients with coronary artery disease (CAD).Methods A total of 622 patients receiving coronary angiography from January 2015 to December 2015 were retrospectively studied.They were divided into two groups according to the findings on coronary angiography.Those with ≥ 50％ stenosis were defined as coronary artery disease.According to SYNTAX score,CAD patients were divided into three groups:low risk group (1-22),moderate risk group (23-32) and high risk group (＞ 33).Fasting serum Hcy levels,fasting serum uric acid levels,fasting blood lipids including total cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined.Then,patients were divided into two groups according to the serum Hcy level for observing the relationship between the serum Hcy and the SYNTAX score.Results TC,LDL-C were significant higher in SYNTAX score high-risk group and moderate risk group compared with normal group.There were no statistically significant differences in TC and LDL-C between the normal group and the low-risk group (P ＞ 0.05).Compared with normal coronary group,Hcy in high risk group and moderate risk group was significant higher.There were no statistically significant differences in age,sex,TC,TG,HDL-C,LDL-C between normal Hcy group and high Hcy group (P ＞ 0.05).The SYNTAX score was significantly higher in high Hcy group than that in normal group (P ＜ 0.05).Multivariate logistic regression analysis suggested that serum Hcy was associated with coronary lesion severity.Compared with normal coronary group in the same gender,uric acid level in high risk group and moderate risk group was significant higher (P ＜ 0.05).Multivariate logistic regression analysis showed that serum uric acid was associated with coronary lesion severity.(P ＜ 0.05) Conclusions Serum Hcy and high uric acid level are the risk factors of coronary lesion severity.With the increased Hcy level and uric acid level,the increase in the severity degree of coronary artery lesions represents a greater cardiovascular risk.