MTHFR C677T基因多态性对稳定性冠心病患者叶酸降低同型半胱氨酸治疗的影响

目的探讨MTHFR C677T基因多态性对河南中部汉族稳定性冠状动脉粥样硬化性心脏病(冠心病)患者叶酸降低同型半胱氨酸(Hcy)治疗的影响。方法连续入选2018年4月至2018年9月于许昌市中心医院心血管内科住院的冠心病患者362例,依据MTHFR C677T基因检测结果分为A(CC型)、B(CT型)、C(TT型)三组,三组患者均在冠心病二级预防治疗的基础之上给予叶酸片降低Hcy治疗。记录患者应用叶酸治疗前、治疗后1个月、3个月血浆Hcy的变化,计算三组治疗3个月时降低Hcy治疗有效率,并对影响降低Hcy治疗的因素进行二元logistic回归分析。结果A、B、C三组分别有81例(22.4%)、169例(46.7%)和112例(30.9%)患者,三组治疗前血浆Hcy水平差异无统计学意义(P>0.05);三组治疗1个月和3个月血浆Hcy水平均低于治疗前,且A组治疗1个月时血浆Hcy水平低于B组和C组,差异均有统计学意义(P<0.05)。A组治疗有效率高于B组和C组,差异有统计学意义(P<0.05)。二元logistic回归分析显示,CC型患者降低Hcy治疗有效的可能是TT型患者的2.626倍,有熬夜史患者降低Hcy治疗有效的可能是无熬夜史患者的44.3%。结论MTHFR C677T基因多态性对稳定性冠心病患者叶酸降低Hcy治疗有影响,患者在降低Hcy治疗时应改变熬夜习惯。

Effects of MTHFR C677T gene polymorphism on folic acid-lowering homocysteine therapy in patients with stable coronary heart disease

Objective To investigate the effect of MTHFR C677T gene polymorphism on folic acid-lowering homocysteine(Hcy)treatment in patients with stable coronary heart disease in the Han population in central Henan.Methods According to the results of MTHFR C677T gene detection,362 patients with SCAD combined with hyperhomocysteinemia(HHcy)of Han population in central Henan were divided into three groups:A(CC),B(CT)and C(TT).All the three groups were treated with folic acid tablets to reduce Hcy therapy on the basis of secondary prevention and treatment of coronary heart disease.The changes of plasma Hcy were recorded before and after folic acid treatment for 1 month and 3 months.The effective rate of lowing Hcy was calculated at 3 months after folic acid treatment,and the factors affecting the lowing Hcy therapy were analyzed by binary logistic regression.Results There were 81 patients(22.4%),169 patients(46.7%)and 112 patients(30.9%)in group A,B and C,respectively.There was no significant difference in plasma Hcy levels before treatment in the three groups(P>0.05).The plasma Hcy levels in the three groups were lower than those before treatment for one month and three months,and the plasma Hcy levels in group A were lower than those in group B and C at one month of treatment(P<0.05).The effective rate of lowing Hcy in group A was higher than that of group B and group C(P<0.05).Bivariate logistic regression analysis showed that the possibility of lowering Hcy effective treatment in CC type is 2.626 times of TT type,and the possibility of lowering Hcy effective treatment in patients with a history of staying up late is 44.3% of patients without a history of staying up late.Conclusion MTHFR C677T gene polymorphism has an effect on folic acid lowering Hcy therapy in patients with SCAD,and patients with SCAD should change the habit of staying up late when reducing Hcy therapy.