The Effct On Hcy And CRP In Patients With CHD Of Hyperhomocysteinemia After PCI By Folic Acid And Vitamin B₁2

Objective:Coronary heart disease(CHD)has been the most common cause of human death. The pathological mechanisms of CHD including smooth muscle cell proliferation, endothelial dysfunction, thrombosis formation and platelet activation. Percutaneous coronary intervention(PCI)is one of the primary means of treatment of severe CHD at present, but even in the era of drug-eluting stents, there is a chance of in-stent restenosis(ISR)after PCI and the incidence of major adverse cardiovascular events(MACE) is still high.It has been the main factor influencing the long-term effect and prognosis. C reactive protein(CRP)has been proved to be an important marker of inflammatory response and lesions.Hyperhomocysteinemia(HHcy)is emerging as an independent CHD risk factor other than CRP and other risk factor,it has been also confirmed that HHcy is an important risk factor for the occurrence of ISR and MACE after PCI. This may be related to the vascular inflammatory reaction’s enhancement caused by increased Hcy.The purpose of this study is to investigate the effct of Hcy and CRP in patients of CHD with Hyperhomocysteinemia after PCI by folic acid and vitamin B12, explore the possibility to reduce the concentrations of CRP and Hcy and the incidence of MACE after PCI by folic acid and vitamin B12 to provide clinical evidence for treatment.Methods: The study group consists of 90 patients with CHD in cardiac center of the central hospital of Cangzhou city(Hcy≥10μmol/L).All the patients were treated of PCI. All the patients were randomly divided into 2proups. The patients in the treatment group were given folic acid(5mg/d) and vitamin B12(250μg/d) orally other than routine treatment,and the patients in control group were given the basic treatment.Exclusion criteria: all kinds of rheumatic heart valve disease, severe liver and kidney dysfunction, acute and chronic infection, cancer, autoimmune disease, peripheral vascular and cerebral vascular disease, acute leukemia, organ transplantation, and the vitamin takes the estrogen decrease.Gender, age, hypertension, diabetes TG, TC, LDL-C, VLDL-C, HDL-C, CHD family history and smoking in this two groups were recorded in detail.Blood sampling:Peripheral bloods samples were taken after the patients came into the hospital immediately.The blood samples were taken again after 3 days,1month, 3months and 6months after PCI respectively. The samples were stored at-80℃ and analyzed in a single batch for the study, patients management was independent of these rseults.The levels of CRP and Hcy were tested with ELISA.Statistics analysis: the data were analyzed by statistical software SPSS 17.0. Firstly,Initially the homogeneity of variance between two groups was analyzed.The numerical data was shown as mean±standard deviation. The q test was used to compare diversity and students t test and analysis of variance were used to establish significance. Chi-square test was used for analysis of categorical data. Linear Correlation analysis was used to measure the coeficient of correlation about the correlation data. We took P<0.05 as statistic signifycance level.Results:1 There was no statistical diference between the treatment group and the control group about generalclinical features. 2 The linear correlation analysis between CRP and Hcy showed: Hcy was positively associated with CRP, and the correlation coefficient r were 0.437. 3 Comparison between the groups of each parameter 3.1 The levels of Hcy and CRP were no significant difference between treatment group and control group at baseline. 3.2 The Hcy concentrations after post-treatment were lower than those of pre-treatment in treatment group after 1,3,6months(15.44±2.76,12.14±1.55, 8.76±1.02μmol/L).The Hcy concentrations of post-treatment were no significant lower than those of pre-treatment in control group after 1,3,6month(16.81± 4.53, 15.91± 4.11, 15.81±4.53μmol/L).The concentration of the Hcy has decreased in two groups, but the treatment group decreased higher than that of control group,and there was statistical significance in these two groups(P<0.05). 3.3The CRP concentrations of post-treatment was lower than pre-treatment in both treatment group and control groups,the lowering CRP concentrations in treatment group were higher than those in control group, but there was no statistical significance of these two groups(P>0.05). 3.4 The MACE of two groups patients at different time points:Postoperative 1 month and 3 months the treatment group has slightly lower incidence of MACE, but there was no significant difference between two groups(P>0.05). After 6 months the incidence of MACE of treatment group was lower than control group, and there was significant difference between two groups(P<0.05).Conclusions:1 In this experiment folic acid and vitamin B12 can reduce the concentration of Hcy in patients with Hyperhomocysteinemia after PCI.2 In this experiment folic acid and vitamin B12 can reduce the incidence of MACE in patients with Hyperhomocysteinemia after PCI.3 In this experiment folic acid and vitamin B12 can reduce the concentration of CRP in patients with Hyperhomocysteinemia after PCI.