高 Hcy 血症合并冠心病血栓前状态特点及其对患者长期血栓事件发生的影响

【目的】探讨高同型半胱氨酸（Hcy）血症合并冠心病（CHD）患者血栓前状态特点及其对患者长期血栓事件发生的影响。【方法】选择356例 CHD 患者作为研究对象，根据其血清 Hcy 水平将其分为高 Hcy 组（ n ＝120）和 Hcy 正常组（ n ＝236），所有患者均检测血栓前状态指标，比较两组差异；所有患者均进行随访，比较两组血栓事件发生情况。【结果】33．7％（120／356）CHD 患者为高 Hcy 血症。高 Hcy 组凝血因子Ⅱ片段1＋2（F1＋2）、凝血酶抗凝血酶复合物（TAT ）、凝血酶调节蛋白（TM ）、P‐选择素（GMP‐140）、内皮素‐1（ET‐1）水平均明显高于 Hcy 正常组，而血管性血友病因子（vWF）、抗凝血酶‐Ⅲ（AT‐Ⅲ）低于 Hcy 正常组，差异比较有统计学意义（ P＜0．05）。校正相关指标后血清 Hcy 水平与 F1＋ 2 、TM 存在正相关关系，与 vWF 、AT‐Ⅲ存在负相关关系（ P 均＜0．05）。高 Hcy 组急性心肌梗死、短暂性脑缺血发作、急性脑梗死、急性肺栓塞、下肢静脉血栓形成比例明显高于 Hcy 正常组，差异有统计学意义（ P ＜0．05）。年龄、糖尿病史、高血压病史、血清 Hcy 水平增高、低密度脂蛋白胆固醇水平升高是影响血栓性事件发生的高危因素（ P ＜0．05）。【结论】高 Hcy 血症合并冠心病患者血栓前状态存在促凝指标升高，抗凝指标降低的特点，血清 Hcy 水平增高是血栓性事件发生的一个重要的高危影响因素。

High Homocysteine (Hcy) with Coronary Heart Disease (CHD) and Their Effects on the Long-Term Thrombotic Events

Objective]To investigate the characteristics of high homocysteine (Hcy) patients with coronary heart disease (CHD) and their effects on the long‐term thrombotic events .Methods]356 CHD patients as the re‐search objects ,according to their Hcy levels were selected and divided into high Hcy group ( n = 120) and Hcy normal group ( n = 236) .All patients were detected in the pre thrombotic state indicators ,differences of the two groups were compared and followed up ,and the comparison of the two groups of thrombotic events was conduc‐ted .Results]The coagulation factor Ⅱ fragment 1 + 2 (F1 + 2) ,thrombin anticoagulant complex (TAT) ,throm‐bin regulatory protein (TM ) ,P‐ select element (GMP‐140) ,endothelin ‐1 (ET‐1) levels of the high Hcy group were significantly higher than those of the Hcy normal group ,and von Willebrand factor (VWF) ,antithrombin Ⅲ(AT‐ Ⅲ ) were lower than those of the Hcy normal group ,the difference had statistical significance ( P < 0 .05) . After correction of the relevant indicators ,serum Hcy levels were positively correlated with F1 + 2 and TM ,and negatively correlated with vWF and AT‐ (mean P < 0 .05) .The acute myocardial infarction ,transient ischemic at‐tack ,acute cerebral infarction ,acute pulmonary embolism and lower ratio of limb venous thrombosis of the high Hcy group were significantly higher than those of the normal Hcy group ,the difference was statistically significant ( P < 0 .05) .Increased age ,history of diabetes ,hypertension ,increased serum Hcy levels and increased low den‐sity lipoprotein cholesterol levels were the high risk factors of influence to thrombotic events ( P < 0 .05) .Conclu‐sion]High homocysteine (Hcy) patients complicated with coronary heart disease present an the characteristics of increasing pre thrombotic state and of the reduction of the anticoagulant index .Elevated serum Hcy level is an im‐portant factor to affect the risk of thrombotic events occurred .