贾圣英,谢莲娜,姜春玲,魏显敬,解泽宙,肖兴平,栾波涛

• 1:大连大学附属中山医院循环四科

摘要(Abstract)：

目的探讨同型半胱氨酸水平对高血压病合并急性心肌梗死患者预后的影响。方法选取2012年1月至2017年1月于大连大学附属中山医院就诊的高血压病合并急性心肌梗死患者284例。依据同型半胱氨酸水平将患者分为H型高血压组(同型半胱氨酸≥10μmol/L)204例,单纯高血压组(同型半胱氨酸<10μmol/L)80例。分析两组生化指标、GRACE评分、Gensini评分、冠状动脉病变情况及住院期间与随访1年主要不良心血管事件(MACE)。采用单因素分析及多因素Cox回归分析探讨高血压病合并急性心肌梗死预后的影响因素。结果 H型高血压组患者男性比例高于单纯高血压组(74.5%比51.2%,P<0.001)差异有统计学意义。H型高血压组患者同型半胱氨酸[13.87(11.69,17.99)μmol/L比8.64(7.94,9.39)μmol/L,P<0.001]、尿酸[(376.54±68.34)μmol/L比(340.48±91.73)μmol/L,P=0.009]、血肌酸酐[(89.06±39.30)μmol/L比(66.36±15.27)μmol/L,P<0.001]及N末端B型脑钠肽前体[758.0(247.3,2380.5)pg/ml比418.7(164.95,1157.0)pg/ml,P=0.006]均高于单纯高血压组,差异均有统计学意义。H型高血压组患者左心室射血分数低于单纯高血压组患者[(57.65±8.96)%比(60.47±8.84)%,P=0. 018],差异有统计学意义。H型高血压组患者GRACE评分高于单纯高血压组患者[(113.32±25.36)分比(106.09±23.85)分,P=0.029],差异有统计学意义。两组患者Gensini评分比较,差异无统计学意义(P=0.803)。随访1年,H型高血压组MACE发生率与单纯高血压组比较,差异有统计学意义(21.1%比11.2%,P=0.036)。随访1年以MACE为因变量行Cox多因素回归分析,发现同型半胱氨酸、Gensini评分是随访1年MACE的独立危险因素。结论 H型高血压合并急性心肌梗死患者更易出现肾功能及心功能不全,同型半胱氨酸及Gensini评分增加此类患者远期不良预后的发生,同型半胱氨酸可作为高血压病合并急性心肌梗死远期预后的一项独立危险因素。

关键词(KeyWords)： H型高血压;急性心肌梗死;同型半胱氨酸;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 贾圣英,谢莲娜,姜春玲,魏显敬,解泽宙,肖兴平,栾波涛

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