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中华诊断学电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 48 -52. doi: 10.3877/cma.j.issn.2095-655X.2022.01.010

临床研究

血浆同型半胱氨酸水平对女性高血压患者冠状动脉病变的预测价值
蔺曜1, 黄晓玲1,†(), 何昭霞1, 牟博勇1, 牟燕1   
  1. 1. 611130　成都市温江区人民医院（四川省人民医院温江医院）心血管内科
  • 收稿日期:2020-12-11 出版日期:2022-02-26
  • 通信作者: 黄晓玲

The predictive value of plasma homocysteine for coronary artery disease in female patients with hypertension

Yao Lin1, Xiaoling Huang1,†(), Zhaoxia He1, Boyong Mou1, Yan Mou1   

  1. 1. Department of Cardiovascular Medicine, Wenjiang District People′s Hospital of Chengdu (Sichuan Provincial People′s Hospital Wenjiang Hospital), Chengdu 611130, China
  • Received:2020-12-11 Published:2022-02-26
  • Corresponding author: Xiaoling Huang
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蔺曜, 黄晓玲, 何昭霞, 牟博勇, 牟燕. 血浆同型半胱氨酸水平对女性高血压患者冠状动脉病变的预测价值[J/OL]. 中华诊断学电子杂志, 2022, 10(01): 48-52.

Yao Lin, Xiaoling Huang, Zhaoxia He, Boyong Mou, Yan Mou. The predictive value of plasma homocysteine for coronary artery disease in female patients with hypertension[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(01): 48-52.

目的

探讨血浆同型半胱氨酸(Hcy)水平对女性高血压患者冠状动脉病变的预测价值。

方法

回顾性分析2018年6月至2020年9月在成都市温江区人民医院行冠状动脉检查的原发性高血压女性患者231例，收集患者入院时实验室指标。根据冠状动脉病变SYNTAX评分，将患者分为冠状动脉正常组(n＝163)与冠状动脉病变组(n＝68)，比较两组患者上述各指标，并采用多因素Logistic回归分析各因素对患者冠状动脉病变的影响，并以受试者工作特征(ROC)曲线判断各指标对冠状动脉病变的预测价值。

结果

各指标中，冠状动脉病变组与正常组中年龄[(65.82±5.88)岁，(62.09±4.92)岁]、白细胞计数[(6.82±1.54)×109/L，(5.73±1.09)×109/L]、中性粒细胞计数[(4.71±1.29)×109/L，(3.88±0.84)×109/L]、低密度脂蛋白胆固醇水平[(3.24±0.42)mmol/L，(2.75±0.51)mmol/L]、同型半胱氨酸水平[(32.05±6.83)μmol/L，(14.27±3.84)μmol/L]比较，均差异有统计学意义(t＝4.95，6.10，5.79，6.99，25.10；均P<0.01)。多因素Logistic回归分析结果显示，低密度脂蛋白胆固醇[OR＝1.449，95%CI(1.016~2.066)]及Hcy[OR＝1.493，95%CI(1.064~2.096)]水平升高为女性高血压患者冠状动脉病变的危险因素(均P<0.05)。ROC曲线分析结果显示，低密度脂蛋白胆固醇及Hcy预测的截断值分别为2.96 mmol/L、25.03 μmol/L；曲线下面积(AUC)分别为0.650，0.796；两者联合诊断的AUC为0.879，其诊断效能高于各单独指标(Z＝4.26，4.72；均P<0.05)。

结论

低密度脂蛋白胆固醇及Hcy水平升高为女性高血压患者冠状动脉病变的危险因素，两者联合检测可有效提高冠状动脉病变的预测效果。

关键词: 同型半胱氨酸, 女性, 高血压, 冠状动脉疾病, 预测
Objective

To explore the predictive value of plasma homocysteine (Hcy) for coronary artery disease (CAD) in female hypertensive patients.

Methods

From June 2018 to September 2020, 231 female patients with essential hypertension who underwent CAD in Wenjiang District People′s Hospital of Chengdu were selected. The laboratory indicators at the time of admission were collected, and the patients were divided into the normal coronary artery group (n=163) and the CAD group (n=68) according to the CAD SYNTAX score. The above indicators of the two groups of patients were compared, the influence of each indicator on CAD was analyzed by the multivariate logistic regression analysis method, and the predictive value of each indicator on CAD was judged by receiver operating characteristic (ROC) curve.

Results

Among the indicators, the differences age [(65.82±5.88)years, (62.09±4.92)years], leukocyte count [(6.82±1.54)×109/L, (5.73±1.09)×109/L], neutrophil count [(4.71±1.29)×109/L, (3.88±0.84)×109/L], low-density lipoprotein cholesterol level [(3.24±0.42)mmol/L, (2.75±0.51)mmol/L] and homocysteine level [(32.05±6.83)μmol/L, (14.27±3.84)μmol/L] between the CAD group and the normal group were statistically significant (t=4.95, 6.10, 5.79, 6.99, 25.10, all P<0.01). The multivariate logistic regression analysis results on a single factor basis showed that elevated levels of low-density lipoprotein cholesterol [OR=1.449, 95%CI (1.016-2.066)] and Hcy [OR=1.493, 95%CI (1.064-2.096)] were risk factors for CAD in female hypertensive patients (all P<0.05). ROC curve analysis results showed that the cut-off values of low-density lipoprotein cholesterol and Hcy for predicting CAD were 2.96 mmol/L and 25.03 μmol/L, respectively, and area under curve (AUC) were 0.650, 0.796. The AUC of the two indicators combined diagnosis was 0.879, and its diagnostic efficiency was higher than that of each indicator alone (Z=4.26, 4.72, all P<0.05).

Conclusions

Elevated levels of low-density lipoprotein cholesterol and Hcy are risk factors for CAD in female hypertensive patients. The combined detection of the two indicators can effectively improve the predictive effect of CAD.

Key words: Homocysteine, Female, Hypertension, Coronary artery disease, Forecasting
表1 两组女性高血压患者冠状动脉病变的单因素分析(±s)
因素 冠状动脉病变组(n＝68) 冠状动脉正常组(n＝163) t值 P值
年龄(岁) 65.82±5.88 62.09±4.92 4.95 0.000
体重指数(kg/m2) 24.92±3.71 23.86±3.85 1.93 0.055
白细胞计数(×109/L) 6.82±1.54 5.73±1.09 6.10 0.000
中性粒细胞计数(×109/L) 4.71±1.29 3.88±0.84 5.79 0.000
淋巴细胞计数(×109/L) 1.56±0.28 1.60±0.33 -0.88 0.382
总胆红素(μmol/L) 10.27±2.58 10.41±2.72 -0.36 0.718
糖化血红蛋白(%) 5.47±1.27 5.59±1.31 -0.64 0.523
空腹血糖(mmol/L) 4.82±1.15 4.90±1.28 -0.45 0.656
总胆固醇(mmol/L) 4.63±1.19 4.75±1.24 -0.68 0.498
甘油三酯(mmol/L) 1.65±0.51 1.74±0.38 -1.48 0.141
低密度脂蛋白胆固醇(mmol/L) 3.24±0.42 2.75±0.51 6.99 0.000
高密度脂蛋白胆固醇(mmol/L) 1.66±0.37 1.58±0.33 1.62 0.108
尿素氮(mmol/L) 4.86±1.49 4.97±1.51 -0.51 0.613
肌酐(μmol/L) 66.74±12.61 68.75±13.09 -1.08 0.283
丙氨酸转氨酶(U/L) 17.81±3.47 18.25±3.53 -0.87 0.386
天冬氨酸转氨酶(U/L) 23.63±3.57 24.14±3.88 -0.93 0.352
同型半胱氨酸(μmol/L) 32.05±6.83 14.27±3.84 25.10 0.000
雌二醇(pmol/L) 57.24±6.99 58.11±7.25 -0.84 0.402
雌三醇(pmol/L) 15.27±2.81 15.70±3.04 -1.00 0.318
孕酮(mmol/L) 9.51±2.84 9.39±2.77 0.30 0.766
表2 女性高血压患者冠状动脉病变的多因素Logistic回归分析
变量 B SE Wald χ 2 P值 OR值 OR值95%CI
下限 上限
年龄(岁) 0.352 0.189 3.469 0.074 1.422 0.982 2.059
白细胞计数(×109/L) 0.338 0.174 3.773 0.059 1.402 0.997 1.972
中性粒细胞计数(×109/L) 0.307 0.177 3.008 0.097 1.359 0.961 1.923
低密度脂蛋白胆固醇(mmol/L) 0.371 0.181 4.201 0.032 1.449 1.016 2.066
同型半胱氨酸(μmol/L) 0.401 0.173 5.373 0.008 1.493 1.064 2.096
图1 不同指标诊断女性高血压患者冠状动脉病变的ROC曲线注：Hcy为同型半胱氨酸；ROC为受试者工作特征
表3 女性高血压患者冠状动脉病变ROC曲线分析
指标 截断值 AUC AUC的95%CI P值 敏感度(%) 特异度(%)
低密度脂蛋白胆固醇(mmol/L) 2.96 0.650 0.562~0.739 0.002 72.63 56.17
同型半胱氨酸(μmol/L) 25.03 0.796 0.721~0.872 0.000 78.14 78.28
联合诊断   0.879 0.814~0.943 0.000 89.01 56.20
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