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目的:探讨血浆同型半胱氨酸(H cy)水平与急性冠状动脉综合征(ACS)的关系,并应用药物干预,观察药物对血浆H cy水平的影响。方法:87例ACS患者及97例稳定性心绞痛患者(对照组),均在住院第二日晨采集静脉血检测H cy,总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C)水平,两组进行对比分析。第三日起给予ACS组高H cy患者口服叶酸、维生素B6,观察用药后4周、8周的血浆H cy变化。结果:ACS组H cy水平明显高于稳定性心绞痛组(对照组),P<0.01;而两组的TC、TG、HDL-C、LDL-C水平却无显著性差异(P>0.05)。用药后4周ACS组36例(44.45%)患者H cy水平下降至正常,8周后ACS组患者H cy水平全部降至正常。结论:ACS患者的H cy与血脂水平并不相关,是独立于传统危险因素之外的又一主要危险因素,应用叶酸、维生素B6治疗,H cy可于8周后全部降至正常水平,可用于ACS的一级预防用药。
Objective: To investigate the relationship between plasma homocysteine (Hcy) level and acute coronary syndrome (ACS) and to investigate the effect of drugs on H cy level in plasma. Methods: Eighty-seven patients with ACS and 97 patients with stable angina pectoris (control group) were enrolled in the hospital the next morning to collect blood samples for detection of Hcy, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were compared between the two groups. From the third day, folic acid and vitamin B6 were given orally to patients with high H cy in ACS group, and plasma Hcy changes were observed after 4 and 8 weeks of treatment. Results: The level of cystine in ACS group was significantly higher than that in stable angina pectoris group (P <0.01). There was no significant difference in the levels of TC, TG, HDL-C and LDL-C between the two groups (P> 0.05). H cy levels in 36 patients (44.45%) in ACS group decreased to normal after 4 weeks of treatment, and H cy levels in ACS group decreased to normal after 8 weeks. Conclusions: H cy in patients with ACS is not related to the level of serum lipids, and is another major risk factor independent of traditional risk factors. Hcy treatment with folic acid and vitamin B6 can all be reduced to normal level after 8 weeks, Primary prevention in ACS.