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冠心病是严重危害人类健康的世界问题,且发病具有年轻化趋势,日益受到关注。冠心病的危险因素多样,导致其发病的机制复杂。早期识别和干预冠心病的可逆性致病因子对减少冠心病的发病率和改善冠心病病人临床症状及预后意义重大。血清同型半胱氨酸(HCY)是含巯基的氨基酸,是含硫氨基酸转化过程的中间形式[1]。目前认为高HCY水平是导致心血管疾病发病的独立危险因素。研究[2]认为,HCY导致冠心病可能与损伤血管内皮细胞、氧化应激、促进炎症反应、促进平滑肌细胞增殖、血管钙化等有密切关联。本研究按照对冠心病病人血清HCY水平不同进行分组,探讨其与冠心病的相关性, 并初步探讨其导致冠心病发病的可能机制。现作报道。
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冠心病组中HHCY血症发病率为40%(64/160), 明显高于对照组的15%(6/40)(χ2=8.79, P < 0.01)。
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HHCY组和非HHCY组性别、年龄、高血压、血脂异常、尿酸(UA)、空腹血糖(FBG)差异均无统计学意义(P>0.05),2组体质量指数(BMI)、吸烟、HCY、IL-6、NO、ET-1差异均有统计学意义(P<0.01)(见表 1)。
指标 HHCY组
(n=64)非HHCY组
(n=96)t P 性别/(男/女) 37/27 54/42 0.04△ >0.05 年龄/岁 67.35±8.79 65.83±4.85 1.40 >0.05 BMI/(kg/m2) 25.30±1.38 22.43±1.33 13.17 < 0.01 吸烟 34(53.0) 28(29.0) 9.29△ < 0.01 高血压 23(36.0) 31(32.0) 0.23△ >0.05 血脂异常 13(20.0) 22(23.0) 0.15△ >0.05 UA/(μmol/L) 363.76±68.83 347.96±60.03 1.54 >0.05 FBG/(mmol/L) 5.55±0.83 5.51±0.60 0.35 >0.05 IL-6/(ng/L) 14.85±0.71 8.88±0.56 59.27 < 0.01 ET-1/(ng/L) 66.77±3.41 54.41±2.51 26.39 < 0.01 NO/(μmol/L) 27.29±2.26 36.58±1.78 27.66 < 0.01 HCY/(μmol/L) 14.98±2.21 6.83±1.46 25.97 < 0.01 △示χ2值 表 1 各指标在HHCY组和非HCY组比较(x±s)
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HCY和IL-6、ET-1均呈正相关关系(r=0.820、0.620,P < 0.01),HCY和NO呈负相关关系(r=-0.630,P < 0.01)。
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HHCY组中急性冠状动脉综合征(ACS)发病率为26.6%(17/64), 明显高于非HHCY组的10.4%(10/96)(χ2=7.14, P < 0.01)。
高同型半胱氨酸血症与血清白细胞介素-6、内皮素-1及一氧化氮的相关性研究
Correlation study between the levels of serum interleukin 6, endothelin 1 and nitric oxide, and hyperhomocysteinemia
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摘要:
目的研究冠心病病人血清同型半胱氨酸(HCY)与白细胞介素(IL)-6、内皮素(ET)-1、一氧化氮(NO)之间的相关性。 方法选取经冠状动脉造影确诊为冠心病的病人160例为观察组,其中合并高同型半胱氨酸血症者64例为HHCY组,同型半胱氨酸水平正常者96例为非HHCY组,另选取同期冠状动脉造影阴性者40例为对照组。测定血清IL-6、ET-1和NO水平,比较各组间差异。 结果观察组中HHCY血症发病率高于对照组(P < 0.01)。HHCY组和非HHCY组之间体质量指数、吸烟、IL-6、NO、ET-1差异有统计学意义(P < 0.01)。HHCY组中HCY与IL-6、ET-1呈正相关关系(P < 0.01);HCY与NO呈负相关关系(P < 0.01)。HHCY组中急性冠脉综合征发生率明显高于非HHCY组(P < 0.01)。 结论HHCY血症与冠心病的临床严重程度相关。HHCY血症可能通过促进体内炎症反应进一步导致血管内皮功能紊乱而参与了冠心病的发病过程。 Abstract:ObjectiveTo study the correlation between the serum homocysteine(HCY), and interleukin 6(IL-6), endothelin 1(ET-1) and nitric oxide(NO) in patients with coronary heart disease(CHD). MethodsOne hundred and sixty with CHD[including 64 cases with hyperhomocysteinemia(HHCY group) and 96 cases with normal homocysteine(non-HHCY group), and 40 patients with negative coronary angiography were divided into the observation group and control group, respectively.The serum levels of IL-6, ET-1 and NO in all cases were measured, and the difference of which was compared. ResultsThe incidence rate of HHCY in observation group was higher than that in control group(P < 0.01).The differences of the BMI, smoking, IL-6, NO and ET-1 between HHCY group and non-HHCY group were statistically significantly(P < 0.01).In HHCY group, HCY was positively correlated with IL-6 and ET-1(P < 0.01);and HCY was negatively correlated with NO(P < 0.01).The incidence rate of acute coronary syndrome in HHCY group was significantly higher than that in non-HHCY group(P < 0.01). ConclusionsHyperhomocysteinemia is related to the clinical severity of CHD.Hyperhomocysteinemia may be involved in the pathogenesis of CHD by promoting the inflammatory reaction to lead to the dysfunction of vascular endothelium. -
Key words:
- coronary heart disease /
- hyperhomocysteinemia /
- interleukin 6 /
- endothelin 1 /
- nitric oxide
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表 1 各指标在HHCY组和非HCY组比较(x±s)
指标 HHCY组
(n=64)非HHCY组
(n=96)t P 性别/(男/女) 37/27 54/42 0.04△ >0.05 年龄/岁 67.35±8.79 65.83±4.85 1.40 >0.05 BMI/(kg/m2) 25.30±1.38 22.43±1.33 13.17 < 0.01 吸烟 34(53.0) 28(29.0) 9.29△ < 0.01 高血压 23(36.0) 31(32.0) 0.23△ >0.05 血脂异常 13(20.0) 22(23.0) 0.15△ >0.05 UA/(μmol/L) 363.76±68.83 347.96±60.03 1.54 >0.05 FBG/(mmol/L) 5.55±0.83 5.51±0.60 0.35 >0.05 IL-6/(ng/L) 14.85±0.71 8.88±0.56 59.27 < 0.01 ET-1/(ng/L) 66.77±3.41 54.41±2.51 26.39 < 0.01 NO/(μmol/L) 27.29±2.26 36.58±1.78 27.66 < 0.01 HCY/(μmol/L) 14.98±2.21 6.83±1.46 25.97 < 0.01 △示χ2值 -
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