Correlation Analysis Of Serum Homocysteine Level And Coronary Lesions In Patients With Coronary Heart Disease

BACKGROUNDCardiovascular diseases(CVD)have become a main cause of deaths among Chinese people in recent years,among which ischemic cardiomyopathy(ICM)has gradually taken positions of diseases such as rheumatic heart disease(RHD)among patients with CVDs,which became a major disease among patients with ICM in our country.As an important reason of ICM,populations with CHD have increased in recent years,which causes huge capital burdens and health risks for patients with the number of them increasing year by year.Therefore,identifying patients with coronary heart diseases as early as possible,distinguishing extents of diseases and giving relevant diagnoses and treatments in time are extremely important in reducing mortalities and treatment costs.In clinical practices,imaging methods such as coronary CTA or interventional CAG are used to diagnose and determine the severity of coronary lesions.However,those common methods are expensive or require hospitalizations,which make uninsured patients unable to benefit from them.As a result of the fact,it is necessary to find a blood marker that have a strong relationship with severity of coronary diseases,based on which clinical decisions are provide.Over half a century,multiple risk factors have been identified through studies on Atherosclerosis(AS),such as hypertension,hyperlipidemia,obesity,diabetes,related family histories,smoking and many other factors.In recent years,some researches have shown that hyperhomocysteinemia(HHe)is also significantly related to the occurrence of cardiovascular and cerebrovascular diseases.Studies show that Homocysteine(Hcy)contains highly reactive sulfhydryl groups that can cause oxidative stress reactions and increase the risk of AS through multiple ways:(1)Superoxides and peroxides generated by oxidative stress reactions in which they participate can cause damages to vascular endothelium and affect functions of coagulation factors,which could increase the risk of thromboses.(2)By binding to apolipoprotein B(APO B),the dense compounds formed are easy to be engulfed by macrophages,as a result,fat accumulations occur to vessel walls.(3)It can increase high-risk factors of cardiovascular diseases such as hypertension and hyperlipidemia,which further increases the risk of AS.It can be seen that the plasma high homocysteine status plays an important role in pathogeneses of coronary atherosclerotic heart disease(CND).Therefore,finding out correlations between plasma homocysteine levels and degrees of coronary artery diseases will have certain clinical significances.RESEARCH OBJECTIVE(1)To study on correlations between the level of serum homocysteine and the degree of coronary scleroses.(2)To study on feasibility of detecting serum homocysteine level in prediction of severity of coronary artery diseases.RESEARCH METHODS1196 patients hospitalizing in the Department of Cardiology,Qilu Hospital of Shandong University from September 1,2013 to May 1,2017,who have undergone coronary angiographies during hospitalization are included in the study,containing 768 male patients(64.20%)and 428 female patients(35.80%).All patients receive fasting venous blood collection in the morning of the next day after their hospitalization is admitted.Levels of homocysteine,blood creatinine and blood lipid are also measured.According tc results of patients undergoing coronary angiographies,GENSINI grading is adopted to assess degrees of coronary lesions of those patients,who are grouped according to the following two methods:?According to GENSINI grading,they are divided into three groups:mild lesion group(0<GENSINI score ? 20),moderate lesion group(20<GENSINI score<40)and severe lesion group(GENSINI score>40);? Divided into HHcy group and non-Hcy group according to their homocysteine levels.Analyses are made through SPSS24.0 software,during which data conformed to normal distribution is expressed as mean±standard deviation,and that do not conform to normal distribution is expressed as median+(interquartile range).Comparisons among groups should be analyzed through single-factor analyses of variances,a ? test is used to compare the means of both groups,and Pearson correlation analysis is adopted to analyze correlations among those variables.When P<0.05,it will be statistically significant.RESULTSAfter distinguishing the patients according to their degrees of coronary artery diseases,it is concluded that there significant statistical differences among patients of the three groups in age(P= 0.032),eGFR(P= 0.045)and high-density lipoprotein cholesterol(P<0.001).There is no statistically significant difference in triglyceride(P= 0.342)or low-density lipoprotein cholesterol(P= 0.172).Homocysteine level of the mild disease group is(16.17±6.60)?mol/L,that of moderate disease group is(16.91±6.81)?mol/L,and for severe disease group it is(17.84±6.91)?mol/L,which is higher than that of the above groups.Compared with differences between moderate and severe disease groups,which are of no statistical significance,those between mild and severe disease groups are statistically significant(P=0.1721,0.055).(P<0.001).However.Patients in HHcy and non-HHcy groups were compared through two independent sample ? tests.GENSINI score of HHcy group was(46.08 ± 34.57)points,which was significantly higher than that of non-HHcy group,which was(38.93±29.92)points,and the difference was statistically significant(t=-3.822,p<0.001).Pearson correlation analysis was used to analyze the relationship between homocysteine levels and GENSINI scores among all patients,and it was concluded that there was a significant correlation between them(r= 0.102,P<0.001).CONCLUSIONSFor patients with a coronary atherosclerotic heart disease,their serum homocysteine levels are positively correlated with the severity of coronary artery diseases,that is,the higher their serum homocysteine level is,the higher the GENSINI score will be.Clinically,the level of serum homocysteine can be detected to predict the degree of coronary artery lesions of patients,whose risks can be graded,and then corresponding diagnoses and treatment measures can be taken.