CAJ | 학술논문

目的：分析同型半胱氨酸水平对稳定型心绞痛患者介入治疗后血栓弹力图检测结果的影响。方法随机抽取北京安贞医院和阜外医院2011年1月—2013年12月行冠脉介入治疗的患者450例，按照是否合并高同型半胱氨酸血症分为高同型半胱氨酸血症组（ n ＝138）和正常同型半胱氨酸组（n ＝312），2组患者经常规术前检查、药物治疗和冠状动脉支架置入，入院后行常规检查及血栓弹力图检测。分析血栓弹力图各指标在2组间的差异。结果高同型半胱氨酸血症组男性占比、年龄、体质量、吸烟、高血压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、左室射血分数、高敏C反应蛋白显著高于正常同型半胱氨酸组（ P ＜0§．05），多因素回归分析显示，在控制上述组间有统计学差异的各因素之后，高同型半胱氨酸血症与二磷酸腺苷抑制率仍显著相关（ r ＝0．889， P ＝0．000）。2组患者的血栓弹力图主要参数，包括R值、K值、α角和血栓形成的最大幅度（MA）差异均有统计学意义（ P ＜0．05）；2组花生四烯酸（AA）抑制率差异无统计学意义（ P ＝0．072），而二磷酸腺苷（ADP）抑制率差异有显著统计学差异（ P ＝0．000）；且高同型半胱氨酸血症组氯吡格雷抵抗的发生率显著高于正常同型半胱氨酸组（26．8％vs．161．％， P ＝0．022）。结论合并高同型半胱氨酸血症的稳定型心绞痛患者呈现高凝状态，且氯吡格雷抵抗发生率高，提示冠状动脉介入术后需要加强抗血小板治疗以减少心血管事件。
목적：분석동형반광안산수평대은정형심교통환자개입치료후혈전탄력도검측결과적영향。방법수궤추취북경안정의원화부외의원2011년1월—2013년12월행관맥개입치료적환자450례，안조시부합병고동형반광안산혈증분위고동형반광안산혈증조（ n ＝138）화정상동형반광안산조（n ＝312），2조환자경상규술전검사、약물치료화관상동맥지가치입，입원후행상규검사급혈전탄력도검측。분석혈전탄력도각지표재2조간적차이。결과고동형반광안산혈증조남성점비、년령、체질량、흡연、고혈압、저밀도지단백담고순、고밀도지단백담고순、좌실사혈분수、고민C반응단백현저고우정상동형반광안산조（ P ＜0§．05），다인소회귀분석현시，재공제상술조간유통계학차이적각인소지후，고동형반광안산혈증여이린산선감억제솔잉현저상관（ r ＝0．889， P ＝0．000）。2조환자적혈전탄력도주요삼수，포괄R치、K치、α각화혈전형성적최대폭도（MA）차이균유통계학의의（ P ＜0．05）；2조화생사희산（AA）억제솔차이무통계학의의（ P ＝0．072），이이린산선감（ADP）억제솔차이유현저통계학차이（ P ＝0．000）；차고동형반광안산혈증조록필격뢰저항적발생솔현저고우정상동형반광안산조（26．8％vs．161．％， P ＝0．022）。결론합병고동형반광안산혈증적은정형심교통환자정현고응상태，차록필격뢰저항발생솔고，제시관상동맥개입술후수요가강항혈소판치료이감소심혈관사건。
Objective To analysis the effect of homocysteine levels on the detection of the patients with stable angina pectoris after PCI .Methods Randomly selected Beijing Anzhen Hospital and Fuwai Hospital from 2011 January to 2013 De-cember 450 coronary interventional patients , according to whether with high homocysteine hyperlipidemia or not , patients were divided into high homocysteine hyperlipidemia group ( n =138) and normal cysteine groups ( n =312), 2 groups of patients underwent the preoperative examination , drug therapy and coronary artery stent implantation , after admission , they underwent routine examination and thrombosis elastic graph detection .Analysis the index of the blood clots ’ differences between the 2 groups.Results High homocysteine group’s male patients ’ ratio, age, body weight, smoking, hypertension, low density lip-oprotein cholesterol , high density fat cholesterol ,left ventricular ejection fraction , hypersensitive C-reactive protein were sig-nificantly higher than that of normal homocysteine cysteine groups ( P <0.05).Multivariate regression analysis showed that , after control the various factors , statistically significant difference between and hyperhomocysteinemia and diphosphate adeno -sine inhibition rate were still existed (r =0.889, P =0.000).Two groups of patients’ thromboelastography’s main parame -ters, including the R value, value K, alpha angle, and thrombosis of the maximum amplitude (MA) showed significant differ-ences ( P <0.05); arachidonic acid (AA ) inhibition rate’s difference was not statistically significant ( P =0.072) and adenosine diphosphate( ADP) inhibition rate in the two groups had significant statistical differences ( P =0.000);and high homocysteine clopidogrel resistance was significantly higher than that of the normal homocysteine cysteine groups (26 a.8%vs. 16.1%, P =0.022).Conclusion Patients with stable angina pectoris with high homocysteine showed a high level of coagu -lation, and the incidence of clopidogrel resistance was high , suggesting that the need to strengthen anti platelet therapy after coronary intervention to reduce cardiovascular events .