同型半胱氨酸水平对急性冠脉综合征患者预后及出血风险的影响

目的探讨血浆同型半胱氨酸(Hcy)水平对急性冠脉综合征(ACS)患者双联抗血小板治疗的预后及出血风险的影响。方法选取2017年10月至2018年4月于徐州医科大学附属医院确诊为急性冠脉综合征并规律服用双联抗血小板药物的患者179例。根据血浆同型半胱氨酸(Hcy)水平分为两组:①HHcy组(Hcy≥15μmol/L),②对照组(Hcy<15μmol/L),随访6个月,比较两组主要不良心脑血管事件(MACCE)及出血发生情况。结果HHcy组患者随访6月累计MACCE发生率高于对照组患者(19.28%vs.8.30%,P=0.046),出血事件发生率也显著高于对照组患者(37.35%vs.22.92%,P=0.048)。出血事件中以1型出血为主。年龄(OR=1.041,95%CI:1.006~1.076,P=0.022)及高血压(OR=1.947,95%CI:1.022~3.708,P=0.043)是影响Hcy水平独立危险因素。糖尿病(OR=2.781,95%CI:1.104~7.006,P=0.030)、年龄(OR=1.112,95%CI:1.044~1.184,P=0.001)及Hcy水平(OR=3.332,95%CI:2.266~8.771,P=0.015)是影响MACCE发生的独立预测因素。糖尿病(OR=2.470,95%CI:1.222~4.991,P=0.012)及Hcy水平(OR=2.240,95%CI:1.158~4.332,P=0.017)是影响出血事件发生的独立预测因素。结论高Hcy水平与急性冠脉综合征患者双联抗血小板治疗后MACCE事件、出血风险密切相关,且是急性冠脉综合征患者双联抗血小板治疗后发生MACCE事件、出血风险的一个独立预测因子。

Influence of homocysteine level on prognosis and risk of bleeding in patients with acute coronary syndrome

Objective To investigate the influence of homocysteine(Hcy)level on prognosis and risk of bleeding in patients with acute coronary syndrome(ACS)undergone dual anti-platelet therapy(DAPT).Methods ACS patients undergone DAPT(n=179)were chosen from the Affiliated Hospital of Xuzhou Medical University from Oct.2017 to Apr.2018.All patients were divided,according to Hcy level,into high Hcy group(HHcy group,Hcy≥15μmol/L)and control group(Hcy<15μmol/L).All groups were followed up for 6 months,and incidence of major adverse cardiovascular and cerebrovascular events(MACCE)and bleeding events were compared between 2 groups.Results The incidence rate of MACCE was higher(19.28%vs.8.30%,P=0.046),and incidence rate of bleeding events was higher(37.35%vs.22.92%,P=0.048)in HHcy group than that in control group after followed up for 6 months.The bleeding events were mainly type 1 bleeding.Age(OR=1.041,95%CI:1.006~1.076,P=0.022)and hypertension(OR=1.947,95%CI:1.022~3.708,P=0.043)were independent risk factors impacting Hcy level.Diabetes(OR=2.781,95%CI:1.104~7.006,P=0.030),age(OR=1.112,95%CI:1.044~1.184,P=0.001)and Hcy level(OR=3.332,95%CI:2.266~8.771,P=0.015)were independent predictive factors of MACCE incidence.Diabetes(OR=2.470,95%CI:1.222~4.991,P=0.012)and Hcy level(OR=2.240,95%CI:1.158~4.332,P=0.017)were independent predictive factors of bleeding events.Conclusion The higher level of Hcy is closely correlated to MACCE incidence and bleeding risk in ACS patients undergone DAPT,and it is an independent factor for predicting MACCE and bleeding risk after DAPT.