作者：杨宗旺

单位：

543000 广西壮族自治区梧州市人民医院心血管内科

Units：

Department of Cardiovascular Medicine，the People's Hospital of Wuzhou，Wuzhou 543000，China

关键词：

心肌梗死；无症状性心肌梗死；维生素 A；维生素 D；维生素 E；微量元素；铁；锌；铜

Keywords：

Myocardial infarction；Silent myocardial infarction；Vitamin A；Vitamin D；Vitamin E；Traceelements；Iron；Zinc；Copper

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y02

Funds：

梧州市科学研究与技术开发计划项目（201702097）

摘要：

背景　近年来维生素、微量元素及酶类等与心血管疾病的关系逐渐受到临床关注，但目前关于维生素、微量元素与无症状性心肌梗死（SMI）发生发展关系的研究报道较少见。目的　观察 SMI 患者血清维生素和微量元素水平变化，并分析其与疾病严重程度的相关性。方法　选取 2017 年 1 月—2018 年 1 月在梧州市人民医院心血管内科确诊的 SMI 患者 80 例作为观察组，其中 Cohn 分型Ⅰ型 24 例、Ⅱ型 30 例、Ⅲ型 26 例；另选取同期体检健康者 20 例作为对照组。比较两组受试者及不同 Cohn 分型患者血清维生素〔包括维生素 A（VitA）、维生素 D（VitD）、维生素E（VitE）〕及微量元素〔包括铁（Fe）、锌（Zn）、铜（Cu）〕水平；血清维生素、微量元素水平与 SMI 患者 Cohn分型的相关性分析采用 Spearman 秩相关分析。结果　（1）观察组患者血清 VitA、VitD、VitE、Zn、Cu 水平低于对照组，血清 Fe 水平高于对照组（P<0.05）。（2）Cohn 分型Ⅱ型和Ⅲ型患者血清 VitA、VitD、VitE、Zn、Cu 水平低于Ⅰ型，血清 Fe 水平高于Ⅰ型（P<0.05）；Cohn 分型Ⅲ型患者血清 VitA、VitD、VitE、Zn、Cu 水平低于Ⅱ型，血清 Fe 水平高于Ⅱ型（P<0.05）。（3）Spearman秩相关分析结果显示，血清VitA（r s =-0.464）、VitD（r s =-0.789）、VitE（r s =-0.754）、Zn（r s =-0.567）、Cu（r s =-0.757）水平与 SMI 患者 Cohn 分型呈负相关（P<0.05），血清 Fe 水平与 SMI 患者 Cohn 分型呈正相关（r s =0.489，P<0.05）。结论　SMI 患者血清 VitA、VitD、VitE、Zn、Cu 水平升高，Zn 水平降低，且血清VitA、VitD、VitE、Fe、Zn、Cu 水平变化与 SMI 严重程度有关并可能参与 SMI 的发生发展过程。

Abstract：

Background　Relations of vitamins，microelements and enzymes to cardiovascular diseases had attractedclinical attention in recent years，however there is few reports about relations of vitamins and microelements to occurrence anddevelopment of silent myocardial infarction（SMI）at present. Objective　To observe the changes of serum levels of vitaminsand microelements in patients with SMI，to analyze their correlations with severity of illness. Methods　From January 2017 toJanuary 2018，a total of 80 confirmed patients with SMI were selected as observation group in the Department of CardiovascularMedicine，the People's Hospital of Wuzhou，thereinto 24 cases classified as Cohn type Ⅰ，30 cases as Cohn type Ⅱ，26cases as Cohn type Ⅲ；meanwhile 20 healthy people admitted to this hospital for physical examination were selected as controlgroup. Serum levels of vitamins（including VitA，VitD and VitE）and microelements（including Fe，Zn and Cu）werecompared between the two groups and in SMI patients with different Cohn types；Spearman rank correlation analysis was usedto analyze the correlations of serum levels of vitamins and microelements with Cohn type in patients with SMI. Results　（1）Serum levels of VitA，VitD，VitE，Zn and Cu in observation group were statistically significantly lower than those in controlgroup，while serum Fe level in observation group was statistically significantly higher than that in control group（P<0.05）.（2）Serum levels of VitA，VitD，VitE，Zn and Cu in patients with Cohn type Ⅱ or Ⅲ were statistically significantly lower thanthose in patients with Cohn type Ⅰ，while serum Fe level in patients with Cohn type Ⅱ or Ⅲ was statistically significantly higherthan that in patients with Cohn type Ⅰ（P<0.05）；serum levels of VitA，VitD，VitE，Zn and Cu in patients with Cohn typeⅢ were statistically significantly lower than those in patients with Cohn type Ⅱ，while serum Fe level in patients with Cohntype Ⅲ was statistically significantly higher than that in patients with Cohn type Ⅱ（P<0.05）.（3）Spearman rank correlationanalysis results showed that，serum level of VitA（r s =-0.464），VitD（r s =-0.789），VitE（r s =-0.754），Zn（r s =-0.567）and Cu（r s =-0.757） was negatively correlated with Cohn type in patients with SMI，respectively（P<0.05），while serum Felevel was positively correlated with the Cohn type（r s =0.489，P<0.05）. Conclusion　Serum levels of VitA，VitD，VitE，Zn and Cu significantly elevate but serum Fe level significantly decreases in patients with SMI，moreover changes of serumlevels of VitA，VitD，VitE，Fe，Zn and Cu are statistically correlated with the severity of SMI，which may be involved in theoccurrence and development of SMI.

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