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

doi:10.3877/cma.j.issn.2095-655X.2022.01.010

Abstract

Abstract:

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

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]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(01): 48-52.

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References 20

[1]	Ranjith R, Devika P．Clinical correlation between plasma homocysteine level and coronary artery disease in Indian patients[J]．World J Cardiov Dis，2017，7(12): 477-486.DOI: 10.4236/wjcd.2017.712047.
[2]	Cohen E, Margalit I, Shochat T，et al.The relationship between the concentration of plasma homocysteine and chronic kidney disease：a cross sectional study of a large cohort[J]．J Nephrol，2019，32(5): 783-789.DOI: 10.1007/s40620-019-00618-x.
[3]	Zhong C, Xu T, Xu T,，et al.Plasma homocysteine and prognosis of acute ischemic stroke：a gender-specific analysis from CATIS randomized clinical trial[J]．Mol Neurobiol，2017，54(3): 2022-2030.DOI: 10.1007/s12035-016-9799-0.
[4]	Onyemelukwe OU, Maiha BB.Relationship between plasma homocysteine and blood pressure in hypertensive Northern-Nigerians[J]．Afr Health Sci，2020，20(1): 324-337.DOI: 10.4314/ahs.v20i1.38.
[5]	Lima A, Ferin R, Fontes A，et al.Cysteine is a better predictor of coronary artery disease than conventional homocysteine in high-risk subjects under preventive medication[J]．Nutr Metab Cardiovas Dis，2020，30(8): 1281-1288.DOI: 10.1016/j.numecd.2020.04.010.
[6]	Ma Y, Peng D, Liu C，et al.Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases[J]．BMC cardiovas Dis，2017，17(1): 37-43.DOI: 10.1186/s12872-017-0475-8.
[7]	《中国高血压防治指南》修订委员会．中国高血压防治指南2018年修订版[J]．心脑血管病防治，2019，19(1): 1-44.DOI: 10.3969/j.issn.1009-816X.2019.01.001.
[8]	Cohen E, Margalit I, Shochat T，et al.Gender differences in homocysteine concentrations，a population-based cross-sectional study[J]．Nutr Metab Cardiovas Dis，2019，29(1): 9-14.DOI: 10.1016/j.numecd.2018.09.003.
[9]	Yao Y, Gao LJ, Zhou Y, et al. Effect of advanced age on plasma homocysteine levels and its association with ischemic stroke in non-valvular atrial fibrillation[J]．J Geriatr Cardiol，2017，14(12): 743-751.DOI: 10.11909/j.issn.1671-5411.2017.12.004.
[10]	Yang Q, Lu Y, Deng Y，et al.Homocysteine level is positively and independently associated with serum creatinine and urea nitrogen levels in old male patients with hypertension[J]．Sci Rep，2020，10(1): 1-9.DOI: 10.1038/s41598-020-75073-x.
[11]	Borowczyk K, Piechocka J, Gowacki R，et al.Urinary excretion of homocysteine thiolactone and the risk of acute myocardial infarction in coronary artery disease patients：the WENBIT trial[J]．J Intern Med，2019，285(2): 232-244.DOI: 10.1111/joim.12834.
[12]	Pardesi AT, Patil DP, Jadav NB, et al. Plasma homocysteine concentration in acute coronary syndromes[J]．Int J Cur Res Rev Vol，2020，12(18): 14-19.DOI: 10.31782/IJCRR.2020.121814.
[13]	张秦风，高奋，王远，等．H型高血压病人Hcy水平、血压及冠状动脉病变程度的相关性研究[J]．中西医结合心脑血管病杂志，2019，17(20): 3155-3158.DOI: 10.12102/j.issn.1672-1349.2019.20.023.
[14]	Yang B, Fan S, Zhi X, et al. Interactions of homocysteine and conventional predisposing factors on hypertension in Chinese adults[J]．J Clin Hyper，2017，19(11): 1162-1170.DOI: 10.1111/jch.13075.
[15]	Pang H, Fu Q, Cao Q，et al.Sex differences in risk factors for stroke in patients with hypertension and hyperhomocysteinemia[J]．Sci Rep，2019，9(1): 1-9.DOI: 10.1038/s41598-019-50856-z.
[16]	张慢添，吴跃红，彭思苹，等．联合检测血清胱抑素C，同型半胱氨酸及超敏CRP对监测高龄孕妇妊娠期糖尿病病情进展的临床意义[J]．实用检验医师杂志，2020，12(2): 26-28.DOI: 10.3969/j.issn.1674-7151.2020.02.006.
[17]	Lee JY, Kim JM, Kim IT，et al.Relationship between plasma homocysteine level and glaucomatous retinal nerve fiber layer defect[J]．Curr Eye Res，2017，42(6): 918-923.DOI: 10.1080/02713683.2016.1257728.
[18]	Wang F, Sui X, Xu N, et al. The relationship between plasma homocysteine levels and MTHFR gene variation，age，and sex in Northeast China[J]．Niger J Clin Pract，2019，22(3): 380-384.DOI: 10.4103/njcp.njcp_291_18.
[19]	Ohishi T, Fujita T, Suzuki D，et al.Serum homocysteine levels are affected by renal function during a 3-year period of minodronate therapy in female osteoporotic patients[J]．J Bone Miner Metab，2019，37(2): 319-326.DOI: 10.1007/s00774-018-0920-5.
[20]	Yu C, Wang J, Wang F，et al.Inverse association between plasma homocysteine concentrations and type 2 diabetes mellitus among a middle-aged and elderly Chinese population[J]．Nut Metab Cardiovasc，2018，28(3): 278-284.DOI: 10.1016/j.numecd.2017.11.009.

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

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

变量	B	SE	Wald χ ²	P值	OR值	OR值95%CI
变量	B	SE	Wald χ ²	P值	OR值	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

变量	B	SE	Wald χ ²	P值	OR值	OR值95%CI
变量	B	SE	Wald χ ²	P值	OR值	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

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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