64排螺旋CT检测冠状动脉病变与同型半胱氨酸水平的相关性研究

目的 探讨64排螺旋CT(MSCT)检测冠状动脉病变与同型半胱氨酸水平的相关性.方法 入选研究对象87例,均未接受叶酸和(或)维生素B12等治疗,分为急性冠状动脉综合征(ACS)组33例、稳定型心绞痛(SAP)组29例和正常对照组25例,均行冠状动脉MSCT成像检查,根据CT值进一步将ACS和SAP患者分为易损斑块组26例,混合斑块组19例,钙化斑块组17例；对所有研究对象检测血清同型半胱氨酸(Hcy)浓度.结果 3组间血清Hcy浓度按ACS组(16.44±5.48) μmol/L、SAP组(13.06±5.80) μmol/L、正常对照组(9.94±4.23) μmol/L顺序递减(均P＜0.01)；易损斑块组和混合斑块组血清Hcy浓度均高于钙化斑块组,为(16.50±5.24) μmol/L、(15.51±6.24) μmol/L vs(11.63±5.21) μmol/L(均P＜0.01)；ACS组与SAP组斑块构成比不同(x2=7.628,P＜0.05)；ACS组易损斑块检出率(42.4％)高于SAP组(17.2％),ACS组钙化斑块检出率(18.2％)低于SAP组(48.3％)(均P＜0.05)；斑块的不同性质与血清Hcy浓度间存在相关关系(rs=0.467,P＜0.01).结论 冠状动脉MSCT联合血清Hcy化验检查可作为诊断冠心病并预测其严重程度的无创方法在临床上得以应用.

Correlation between 64-slice spiral computed tomography coronary angiography and homocystein in coronary artery disease

Objective To explore the correlation between 64-slice spiral computed tomography （MSCT） coronary angiography and homocystein（Hcy） in coronary artery disease. Methods Eighty-seven patients were divided into three groups：coronary artery syndrome（ACS） group 33 cases, stable angina pectoris（SAP） group 29 cases and healthy control group 25 cases. No one had received drug therapy with folic acid and/or vitamin B12. All patients underwent 64-slice spiral computed tomography angiography to distinguish the different quality of coronary plaques. According to the CT scale, all coronary artery disease patients were divided into vulnerable plaque group, mix plaque group and hard plaque group. Blood samples were taken to measure Hcy level in all patients. Results Mean Hcy level of ACS group （16.44±5.48） μmol/L was the highest while that of healthy control group （9.94±4.23）μmol/L was the lowest（ P 〈0.01）. Mean levels of Hcy in vulnerable and mix plaque groups were respectively higher than that in hard plaque group,（16.50±5.24） μmol/L and （15.51±6.24） μmol/L vs （11.63±5.21）μmol/L （both P 〈0.05）. Plaque composition was different between ACS group and SAP group （x^2 = 7. 628, P 〈 0.05）. Detection rate of vulnerable plaque in ACS group was significantly higher than that in SAP group, 42.4% vs 17.2% （P 〈0.05）. Detection rate of hard plaque in ACS group was lower than that in SAP group, 18.2% vs 48.3% （ P 〈0.05）. The different quality of coronary plaques was correlated with Hcy level（ r, = 0. 467, P 〈0.01）. Conclusion Combining MSCT coronary angiography with serum Hcy level is a non-invasive way, which is helpful to diagnosis of coronary artery disease and evaluation of artery lesions.