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目的:研究老年急性心肌梗死(AMI)患者血清同型半胱氨酸(Hcy)水平变化及其与AMI传统危险因素的相互作用与关系。方法:随机选择60岁以上的冠心病(CHD)患者143例,其中AMI组73例、不稳定型心绞痛(UAP)组37例、稳定型心绞痛(SAP)组33例,选择同期入院与CHD患者具有性别及年龄可比性且排除CHD诊断的患者55例作为对照组,收集临床资料并检测各组Hcy水平,综合分析。结果:血清Hcy水平AMI组较UAP、SAP及对照组,UAP较对照组均显著升高(P<0.05),其他各组间比较均无显著差异;高Hcy血症发生率AMI组显著高于对照组(P<0.05),但与UAP组及SAP组比较无显著差异;AMI组与对照组比较,性别、年龄、吸烟率、体质指数均无显著差异(均P>0.05),高血压、糖尿病、高血脂及高Hcy血症患病率则老年AMI组显著高于对照组(均P<0.05);多因素Logistic回归分析显示性别、高血压、糖尿病、高血脂及血清Hcy水平均是老年AMI的独立危险因子(P<0.05);高血压、糖尿病、高血脂及AMI的发生率高Hcy组显著高于Hcy水平正常组(均P<0.05),但吸烟率、BMI、年龄、性别则无显著差异(均P>0.05)。结论:血清Hcy是老年AMI的一项独立危险因素,Hcy水平升高与高血压、糖尿病、高血脂可能存在交互作用,促进多种危险因素的相互聚集并发生AMI。
Objective: To investigate the changes of serum homocysteine (Hcy) level and its interaction with traditional AMI risk factors in elderly patients with acute myocardial infarction (AMI). Methods: A total of 143 CHD patients over 60 years of age were selected, including 73 AMI patients, 37 unstable angina pectoris (UAP) patients and 33 SAP patients with stable angina pectoris (SAP) Fifty-five patients with gender-ageable diagnosis who excluded CHD were selected as the control group. Clinical data were collected and Hcy level in each group was tested. Results: Serum Hcy level in AMI group was significantly higher than that in UAP group, SAP group and UAP group (P <0.05), but no significant difference was found in other groups. The incidence of hyperhomocysteinemia in AMI group was significantly higher than that in UAP group (P <0.05), but there was no significant difference between UAP group and SAP group. There was no significant difference in sex, age, smoking rate and body mass index between AMI group and control group (all P> 0.05) The prevalence of diabetes mellitus, hyperlipidemia and hyperhomocysteinemia in elderly AMI group was significantly higher than that in control group (all P <0.05). Multivariate logistic regression analysis showed that gender, hypertension, diabetes, hyperlipidemia and serum Hcy levels were all senile (P <0.05). The incidence of hypertension, diabetes mellitus, hyperlipidemia and AMI in Hcy group was significantly higher than that in normal Hcy group (all P <0.05), but smoking rate, BMI, age and sex No significant difference (all P> 0.05). Conclusion: Serum Hcy is an independent risk factor for AMI in the elderly. Hcy levels may interact with hypertension, diabetes mellitus, hyperlipidemia and promote the aggregation of multiple risk factors and AMI.