| Background:Heart failure is the serious manifestation and the end stage of various heart diseases.With the aggravation of population aging,the incidence and prevalence rate of heart failure are increasing,which seriously affect the quality of life of the people.At this stage,the main cause of heart failure is coronary heart diseaseHomocysteine(Homocysteine,Hcy)is a sulfur-containing non-protein amino acid derived from the metabolic process of methionine.It can participate in the process of coronary atherosclerosis and heart failure through a variety of mechanisms.It is considered to be a risk factor for coronary heart disease and heart failure.Normally,there are two ways in which hcy forms methionine through remethylation,or cysteine remethylation by conversion,and methionine is formed by remethylation.One of these is the transfer of folic acid in the form of 5-methyltetrahydrofolic acid catalyzed by methionine synthetase to hcy,to form methionine,a process that relies on folic acid and vitamin B12.This metabolic pathway exists widely in all tissues,so folic acid plays an important role in the metabolic balance of hcy.Controlling plasma homocysteine levels is particularly important for the prevention and treatment of coronary heart disease and heart failure.At present,it is found that folic acid or folic acid combined with vitamin B6 and B12 can be used to accelerate the metabolism of homocysteine and reduce the level of homocysteine in blood,so as to reduce the level of homocysteine in order to slow down coronary heart disease and heart failure.But whether oral folic acid can be used to improve the heart function and structure of heart failure patients with coronary heart disease,and the dose of oral folic acid need to be further explored.Objective:The aim of this study was to observe the relationship between the level of homocysteine and the severity of heart failure,cardiac function and cardiac structure in patients with coronary heart disease,and to observe the effect of 0.8mg/d folic acid supplementation on cardiac structure and function in patients rehospitalization with heart failure.Provide new ideas and plans for the treatment of heart failure.Methods:From January 2016 to May 2018,196 patients with coronary heart disease and heart failure were selected from the Department of Cardiovascular of the second affiliated hospital of Jilin University.There were 108 males and 88 females.To collect and record the general data and history,vital signs,interval of hospitalization,N-Terminal type Brain Natriuretic Peptide precursor(NT-pro BNP)in patients with acute exacerbation of chronic heart failure and two consecutive hospitalization.Left ventricular end diastolic diameter(lvedd)and left ventricular ejection fraction(lvef)were examined by color Doppler echocardiography.Follow up all the patients,observe the interval of re-hospitalization,record the above-mentioned indicators of rehospitalization.All patients were divided into hyperhomocysteinemia group(HHcy group,Hcy > 15?mol/L)and non-hyperhomocysteinemia group(non-HHcy group,Hcy ? 15?mol/L)according to whether or not the plasma homocysteine level was greater than 15?mol/L.All patients were given basic medication for coronary heart disease and heart failure.Among them,hyperhomocysteinemia group(HHcy group)was randomly given some patients with 0.8mg/d folic acid,the patients who were given folic acid supplement were called HHcy intervention group,and only basic drugs without folic acid supplement group were called HHcy non-intervention group.To compare the general data between HHcy group and non-HHcy group,and to compare the correlation between serum Hcy level and cardiac function,cardiac structure related indexes and Doppler ultrasonography results,and to compare the correlation between Hcy level and cardiac function,cardiac structure related indexes and Doppler ultrasonography results in all patients.The general data of HHcy intervention group and HHcy non-intervention group were compared,and the interval between two hospitalizations and the changes of related indexes were compared.The statistical analysis of the data was carried out by spss20.0 statistical software package.The measured data were tested for normality and variance homogeneity.The data in accordance with normal distribution were expressed as mean ±standard deviation.The data in accordance with the bias distribution are expressed as median(25,75 quartiles);The count data is expressed as frequency and percentage.T-test or rank-sum test was used to compare the mean number of samples according to the normal distribution,and the chi-square test was used to express the sample number of counting data.P<0.05 for the difference was considered statistically significant..Results:1.There was no significant difference in(P > 0.05)the sex composition,age,history of hypertension,history of diabetes,history of smoking,history of alcohol drinking,history of atrial fibrillation,total cholesterol,low density lipoprotein,high density lipoprotein,triglyceride,uric acid and so on between HHcy group and nonHHcy group..2.The levels of homocysteine?ejection fraction and left ventricular diameter?NT-pro BNP in non-HHcy group and HHcy group were significantly different(P < 0.05).The ejection fraction in hhcy group was lower than that in non-hhcy group,the left ventricular diameter and NT-pro BNP in hhcy group were higher than that in nonhhcy group.In HHcy group the III grade? IV grade of NYHA were more than in non-HHcy group..3.There was a linear positive correlation between serum Hcy level and serum NT-pro BNP level(r=0.250,P<0.01),LV(r=0.174,P=0.015),and a linear negative correlation between serum Hcy level and EF(r=-0.150,P=0.036)in CHD patients with heart failure.4.Before treatment,there was no significant difference in sex composition,age,history of hypertension,history of diabetes,history of smoking,history of alcohol drinking,history of atrial fibrillation,total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,uric acid,creatinine,Hcy,ejection fraction,leftventricular diameter,NT-pro BNP,NYHA grade in the HHcy intervention group and the HHcy non-intervention group.(P > 0 05).5.The intervals of re-hospitalization between non-HHcy group,HHcy nonintervention group and HHcy intervention group were compared.The rehospitalization interval of non-HHcy group is 7(6,8)months;the re-hospitalization interval of HHcy non-intervention group is 6(5,7)months;the re-hospitalization interval of HHcy intervention group is 6(6,8)months.The re-hospitalization interval of HHcy non-intervention group was significantly shorter than that of non-HHcy group(p < 0.05)and HHcy intervention group(p < 0.05);there was no significant difference between HHcy intervention group and non-HHcy group(p > 0.05).6.The changes of blood lipid and the previous hospitalization were compared in all patients,and the total cholesterol,high-density lipoprotein,low-density lipoprotein were lower(p <0.05)at the time of re-hospitalization,and there was no significant change in triglyceride(p>0.05).The changes of serum lipids,creatinine and uric acid in non-hhcy group,hhcy non-intervention group and hhcy intervention group were compared.Pairwise rank sum test was performed within the group.The levels of cholesterol,low density lipoprotein cholesterol and low density lipoprotein cholesterol decreased significantly in non-hhcy group(P<0.05),and there were no significant changes in triglyceride,high density lipoprotein,uric acid and creatinine(p>0.05).There were no significant changes in serum lipids,creatinine and uric acid in hhcy intervention group.Decrease of total cholesterol and high density lipoprotein in hhcy non-intervention group(P<0.05),and triglyceride,low density lipoprotein,uric acid and creatinine had no significant change(p>0.05).7.The changes of ejection fraction,left ventricular diameter,NT-pro BNP at rehospitalization in non-HHcy group,HHcy intervention group and HHcy nonintervention group were compared.7.1 The level of Hcy in HHcy non-intervention group was 24(20,30)before treatment and 25(20,31)after treatment.There was no significant difference between the two groups(p > 0.05).In HHcy intervention group,the level of Hcy(? mol/l)was 24(19,30)before treatment and 15(12,22)after treatment,and the level of Hcy was significantly decreased after treatment(p < 0.05).7.2 In HHcy non-intervention group,ejection fraction(%)was 41(34,56)before treatment and 40(31,53)after treatment.Ejection Fraction decreased(p < 0.05).In non-HHcy group,the ejection fraction(%)was 53(43,61)before treatment and 53(39,62)after treatment.There was no significant change in ejection fraction(p > 0.05).In HHcy intervention group,the ejection fraction(%)was 52(32,62)before treatment and 51(36,61)after treatment.There was no significant change in ejection fraction(p > 0.05).7.3 The left ventricular diameter in HHcy non-intervention group was 55(48,62)before treatment and 56(49,63)after treatment,and the left ventricular diameter was increased(p < 0.05).The left ventricular diameter in non-HHcy group was 49(44,56)before treatment and 50(44,58)after treatment.There was no significant change in left ventricular diameter(p > 0.05).In the HHcy intervention group,the left ventricular diameter was 52(47,62)before treatment and 51(46,60)after treatment.There was no significant change in left ventricular diameter(p >0.05).7.4 In HHcy non-intervention group,NT-pro BNP(ng/l)was 3750(823,7150)before treatment,4730(1410,8170)after treatment,and NT-pro BNP was significantly increased(p < 0.05).The level of NT-pro BNP(ng/l)in non-HHcy group was 1260(123,4412)before treatment,740(116,5135)in post-treatment group,and there was no significant change in NT-pro BNP level(p > 0.05).In HHcy intervention group,NT-pro BNP(ng/l)was 3030(269,5570)before treatment and 1900(310,7520)after treatment.There was no significant change in NT-pro BNP level(p > 0.05).Conclusion:1.Homocysteine levels affect cardiac function,structure and interval at rehospitalization in patients with coronary heart failure.The patients with heart failure with hhcy who are not treated with folic acid have shorter periods of rehospitalization and more severe heart failure and larger left ventricular diameter during rehospitalization2.Treatment with folic acid supplementation with 0.8mg/d can reduce the level of homocysteine.Compared with patients with coronary heart failure with hhcy without folic acid,0.8mg/d folic acid treatment slowed the rate of rehospitalization in patients with heart failure with hyperhomocysteinemia. |
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