作者：李其华，易秋艳，徐广纳，韦红卫

单位：

545006广西壮族自治区柳州市人民医院全科医学科

Units：

Department of General Medicine, Liuzhou People's Hospital, Liuzhou 545006, China

关键词：

心肌梗死；同型半胱氨酸；院内死亡；危险因素

Keywords：

Myocardial infarction; Homocysteine; In-hospital death; Risk factor

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.209

Funds：

摘要：

目的　探讨血同型半胱氨酸（Hcy）对急性心肌梗死（AMI）患者直接经皮冠状动脉介入治疗（PCI）后院内死亡的影响。方法　选取2015年1月至2018年10月柳州市人民医院心血管内科收治的310例AMI患者作为研究对象，根据入院时血Hcy将其分为高Hcy组（Hcy＞20.0 μmol/L，47例）和低Hcy组（Hcy≤20.0 μmol/L，263例）。比较两组患者一般资料、实验室检查指标、院内死亡率及梗死相关动脉、冠状动脉病变情况。AMI患者直接PCI后院内死亡的影响因素分析采用单因素、多因素Logistic回归分析；绘制ROC曲线以评价血Hcy对AMI患者直接PCI后院内死亡的预测价值。结果　高Hcy组患者年龄大于低Hcy组，高血压发生率、N末端脑钠肽前体（NT-proBNP）、院内死亡率高于低Hcy组（P ＜0.05）。多因素Logistic回归分析结果显示，入院时Killip分级〔OR =3.940，95%CI （1.960，7.920）〕、血Hcy〔OR =8.333，95%CI （1.527，45.474）〕、超敏C反应蛋白（hs-CRP）〔OR =1.025，95%CI （1.009，1.042）〕及严重冠状动脉病变支数〔OR =3.376，95%CI （1.163，9.801）〕是AMI患者直接PCI后院内死亡的独立影响因素（P ＜0.05）。ROC曲线分析结果显示，血Hcy预测AMI患者直接PCI后院内死亡的曲线下面积为0.682〔95%CI（0.516，0.848）〕，最佳截断值为21.2 μmol/L，灵敏度为0.455，特异度为0.880。结论　入院时血Hcy＞20.0 μmol/L的AMI患者直接PCI后院内死亡率较高，且其是AMI患者直接PCI后院内死亡危险因素，应引起临床重视。

Abstract：

Objective　To investigate the impact of blood homocysteine (Hcy) on in-hospital death in patients withacute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) . Methods　A total of 310 AMI patientsadmitted to the Cardiovascular Department, Liuzhou People's Hospital from January 2015 to October 2018 were selected as theresearch objects. They were divided into high Hcy group (Hcy > 20.0 μmol/L, 47 cases) and low Hcy group (Hcy ≤ 20.0 μmol/L,263 cases) . The general data, laboratory indexes, in-hospital death rate, infarct related artery and coronary artery disease werecompared between the two groups. Univariate and multivariate Logistic regression analysis was used to analyze the influencingfactors of in-hospital death in AMI patients after primary PCI; ROC curve was drawn to evaluate the predictive value of Hcy onin-hospital death in AMI patients after peimary PCI. Results　The age in high Hcy group was older than that in low Hcy group,the incidence of hypertension, N-terminal pro-brain natriuretic peptide (NT-proBNP) and in-hospital death rate in high Hcygroup were higher than those in low Hcy group (P < 0.05) . Multivariate Logistic regression analysis showed that Killip grade atadmission [OR =3.940, 95%CI (1.960, 7.920) ] , blood Hcy [OR =8.333, 95%CI (1.527, 45.474) ] , hypersensitive C-reactiveprotein (hs-CRP) [OR =1.025, 95%CI (1.009, 1.042) ] and number of severe coronary artery lesions [OR =3.376, 95%CI (1.163,9.801) ] were independent influencing factors for in-hospital death in AMI patients after primary PCI ( P < 0.05) . ROC curveanalysis showed that the area under the curve of blood Hcy in predicting in-hospital death in AMI patients after primary PCI was0.682 [95%CI (0.516, 0.848) ] , and the best cutoff value was 21.2 μmol/L, the sensitivity was 0.455, the specificity was 0.880.Conclusion　The AMI patients with blood Hcy > 20.0 μmol/L have a higher in-hospital death rate after primary PCI, and it is aindependent risk factor for in-hospital death in AMI patients after primary PCI, which should be paid more attention in clinic.

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