CAJ | 학술논문

目的探讨血清同型半胱氨酸(Hcy)水平与急性肺栓塞患者早期死亡的相关性.方法选择2008年6月至2011年6月解放军总医院收治的186例急性肺栓塞患者,平均年龄(66.8±12.7)岁.根据入选急性肺栓塞患者的血清Hcy平均水平,将入选患者分为高Hcy组(Hcy≥15.2μmol/L,n=95)和低Hcy组(Hcy＜ 15.2 μmol/L,n=91).详细采集病史、检验及辅助检查结果,观察入选患者有无肺栓塞相关的早期死亡事件,并对入组患者进行为期1年的随访.采用单因素与多因素Cox比例危险模型判断血清Hcy水平与急性肺栓塞患者早期病死率的相关性.结果所有患者平均住院时间为1 ～37(10 ±6)d,14.5％(27/186)患者在住院期间死亡,高Hcy组早期病死率明显高于低Hcy组[25.3％ (24/95)比3.3％(3/91),P=0.001].高Hcy组入院时的心率、氧饱和度、右心室扩张、Hcy≥15.2 μmol/L、肌酐水平、肌钙蛋白T(TnT)峰值和深静脉血栓与低Hcy组比较差异有统计学意义(P均＜0.05).校正其他混淆因素,多因素Cox比例风险模型分析显示,Hcy≥15.2 μmol/L(HR=4.10,95％ CI:3.0 ～4.98,P=0.02)、心率(HR =1.10,95％ CI:1.01 ～ 1.20,P=0.03)、深静脉血栓(HR=1.65,95％CI:1.45 ～ 1.76,P=0.03)和年龄(HR =1.10,95％CI:1.02 ～ 1.19,P=0.01)是急性肺栓塞相关的早期死亡的独立预测因子.结论血清Hcy水平与急性肺栓塞患者早期死亡存在相关性.
목적 탐토혈청동형반광안산(Hcy)수평여급성폐전새환자조기사망적상관성.방법 선택2008년6월지2011년6월해방군총의원수치적186례급성폐전새환자,평균년령(66.8±12.7)세.근거입선급성폐전새환자적혈청Hcy평균수평,장입선환자분위고Hcy조(Hcy≥15.2μmol/L,n=95)화저Hcy조(Hcy＜ 15.2 μmol/L,n=91).상세채집병사、검험급보조검사결과,관찰입선환자유무폐전새상관적조기사망사건,병대입조환자진행위기1년적수방.채용단인소여다인소Cox비례위험모형판단혈청Hcy수평여급성폐전새환자조기병사솔적상관성.결과 소유환자평균주원시간위1 ～37(10 ±6)d,14.5％(27/186)환자재주원기간사망,고Hcy조조기병사솔명현고우저Hcy조[25.3％ (24/95)비3.3％(3/91),P=0.001].고Hcy조입원시적심솔、양포화도、우심실확장、Hcy≥15.2 μmol/L、기항수평、기개단백T(TnT)봉치화심정맥혈전여저Hcy조비교차이유통계학의의(P균＜0.05).교정기타혼효인소,다인소Cox비례풍험모형분석현시,Hcy≥15.2 μmol/L(HR=4.10,95％ CI:3.0 ～4.98,P=0.02)、심솔(HR =1.10,95％ CI:1.01 ～ 1.20,P=0.03)、심정맥혈전(HR=1.65,95％CI:1.45 ～ 1.76,P=0.03)화년령(HR =1.10,95％CI:1.02 ～ 1.19,P=0.01)시급성폐전새상관적조기사망적독립예측인자.결론 혈청Hcy수평여급성폐전새환자조기사망존재상관성.
Objective To explore the association between serum homocysteine (Hcy) level and inhospital death in patients with acute pulmonary embolism.Methods A total of 186 acute pulmonary embolism patients [(66.8 ± 12.7) years,89 male] hospitalized in our department between June 2008 and June 2011 were included in this prospective study.Patients were divided into high Hcy group (Hcy ≥ 15.2 μmol/L,n =95) and low Hcy group (Hcy ＜ 15.2 μmol/L,n =91).Patients were followed-up for 1 year for the incidence rate of early death associated with acute pulmonary embolism.The Cox proportional hazard model was used to analyze the relationship between serum Hcy level and early death in acute pulmonary embolism patients.Results Patients were hospitalized for 1-37 days [(10 ± 6) days].In-hospital death rate was 14.5％ (27/186) and was significantly higher in high Hcy group than in low Hcy group [25.3％(24/95)vs.3.3％ (3/91),P =0.001].Univariate Cox regression analysis indicated that admission heart rate,oxygen saturation,enlargement of right ventricle,Hcy ≥ 15.2 μmol/L,serum creatinine level,peak TnT level and deep venous thromhosis (P ＜ 0.05) were independent risk factors for in-hospital death.Multivariate Cox regression analysis showed that Hcy≥ 15.2 μmol/L (HR =4.10,95％ CI:3.00-4.98,P =0.017),admission heart rate (HR =1.10,95％ CI:1.01-1.20,P =0.031),deep venous thrombosis (HR =1.65,95％CI:1.45-1.76,P=0.034) and age (HR =1.10,95％ CI:1.02-1.19,P =0.010)were independent predictors of in-hospital death for acute pulmonary embolism patients.One-year follow up was finished in 142 patients (89.3％).There were 19 deaths (5 due to repeat pulmonary embolism,4 due to decompensated respiratory and/or cardiac diseases,6 due to malignant tumors,2 due to fatal bleeding and 2 due to pneumonia).Death rate was similar between the two groups during follow up.Conclusion Higher serum homocysteine is an independent for in-hospital death for patients with acute puhnonary embolism.