血浆同型半胱氨酸及颈动脉斑块对老年女性冠心病的预测价值

目的 探讨血浆同型半胱氨酸（homocysteine,Hcy）水平及颈动脉内-中膜厚度（intima-media thickness,IMT）对老年女性冠心病的预测价值。方法 年龄≥60岁拟诊冠心病女性患者100例,根据冠状动脉造影结果分为冠心病组67例和非冠心病组33例,冠心病组再分为单支病变组33例,2支病变组26例和多支病变组8例,比较各组血浆Hcy水平、颈动脉IMT及Crouse积分差异;计算IMT预测老年女性冠心病的特异性,敏感性及阳性预测值。结果 冠心病组血浆Hcy（（17.24±7.86）μmol/L）、颈动脉IMT（（0.96±0.32）mm）、颈动脉Crouse积分（12.59±1.83）均高于非冠心病组（（12.92±3.30）μmol/L、（0.75±0.07）mm、4.90±4.50）（P〈0.05）;冠心病各亚组血浆Hcy水平、颈动脉IMT及Crouse积分为多支病变组〉2支病变组〉单支病变组,组间比较差异均有统计学意义（P〈0.05）;以IMT=0.96mm为诊断界点,IMT预测冠心病的特异性、敏感性、阳性预测值分别为78.8%（26/33）、70.1%（47/67）、87.0%（47/54）。结论 血浆Hcy水平及颈动脉IMT与老年女性冠心病发生及冠状动脉病变严重程度相关;血浆Hcy水平联合颈动脉IMT可预测老年女性是否发生冠心病及其严重程度。

Predictive value of plasma homocysteine plus carotid plaque to coronary heart disease in the elderly female patients

Objective To investigate the predictive value of plasma homocysteine （Hcy） plus carotid intima-media thickness （IMT） to coronary heart disease （CHD） in the elderly female patients. Methods A total of 100 female patients aged 60 years or older were divided into CHD group （n= 67） and non-CHD group （n= 33） according to the angiography results. CHD group was redivided into single-vessel lesion group （n = 33）, double-vessel lesion group （n = 26） and multiple-vessel lesion group （n=8）. The plasma Hcy level, carotid IMT and Crouse score were compared among groups. The specificity, sensitivity and positive predictive rate of IMT for CHD in the elderly female patients were calculated. Results Hcy level, carotid IMT and Crouse score were significantly higher in CHD group （（17. 24±7. 86）bLmol/L, （0.96±0.32） mm, 12. 59±1.83） than those in non-CHD group （（12.92±3.30） μmol/L, （0.75±0.07） mm, 4.90± 4.50） （P〈0.05）, and were highest in multiple-vessel lesion group, followed by double-vessel and single-vessel lesion group （P〈0.05）. Taking 0.96 mm as the standard of IMT to predict CHD, the specificity, sensitivity and the positive predictive rate were 78.8% （26/33）, 70.1% （47/67） and 87.0% （47/54）. Conclusion Plasma Hcy level and carotid IMT are closely correlated with the severity of CHD in elderly female patients, and the detection of plasma Hey level and IMT can predict the occurrence of CHD and evaluate its severity.