Significance Of Serum Homocysteine In Coronary Heart Disease Risk And SYNTAX Score

BackgroundCoronary heart disease(CHD)is one of the most serious diseases to human health.CHD refers to the formation of lipid plaques or the instability of coronary atherosclerotic plaques may lead to the coronary stenosis or further aggravate coronary artery stenosis,result in insufficient blood supply to the myocardium,and cause ischemia and hypoxia of myocardial cells,and in severe cases to vascular occlusion and myocardial ischemia.The lipid plaques and the instability of coronary atherosclerotic plaques result from coronary artery endothelial cell injury and atherosclerosis caused by many risk factors.Various of risk factors may result in coronary atherosclerosis,the formation of plaque or make coronary atherosclerotic plaque instability,leading to coronary artery stenosis or further aggravated,myocardial insufficiency of blood supply.Severe cases cause vascular occlusion,leading to myocardial ischemia,injury,myocardial infarction.In addition to age and aspiration,tobacco,alcohol,hypertension,diabetes mellitus,hypercholesterolemia,genetic factorsand other recognized risk factors.In recent years,more and more studies have confirmed that homocysteine(HCY)is an independent risk factor of CHD.And have been confirmed by increasingly clinical studies in recent years that homocysteine is an independent risk factor for coronary atherosclerosis.However,most of the previous studies were in the area of homocysteine and atherosclerotic severity,coronary atherosclerotic plaque risk area was rarely involved.The aim of this clinical study was to elucidate the relationship between serum homocysteine level and atherosclerotic plaque risk.Objective1.To investigate the patients blood homocysteine levels in vulnerable plaque group,stable plaque group and control group differences in the relationship between the degree of risk response in patients with different types of blood homocysteine of coronary heart disease.2.To investigate the difference of serum homocysteine level among single vessel disease,double vessel lesion and three vessel lesion,and to explore the relationship between the changes of serum homocysteine level and the severity of coronary artery disease.3.To investigate the correlation between serum homocysteine level and SYNTAX score,and the relationship between serum homocysteine level and severity in patients with coronary heart disease(CHD).4.To explore the differences of the basic laboratory indexes in vulnerable plaque group,the plaque stable group and the control group,and to find out which indicators are independent risk factors for predicting the severity and severity of coronary artery disease.5.To investigate the difference of serum homocysteine levels in patients with coronary heart disease(CHD).Methods20 cases were selected in January 2017 to December 2017 in Cardiology Department of the second hospital of Shandong University.Patients with acute myocardial infarction who underwent emergency percutaneous coronary intervention and demonstrated atherosclerosis as vulnerable plaque by intravescular ultrasound imaging(IVUS)were denoted as vulnerable plaque group.18 patients undergoing pulse interventional therapy,Recorded as stable plaque group.20 cases with no obvious abnormal coronary arteriography were recorded as control group.In 38 patients with coronary heart disease,the patients were divided into single branch lesion group,double branch lesion group and three lesion group according to the results of coronary arteriography.Analysis of the relationship between the degree of coronary disease severity and criticality and risk factors,so as to find out what several indicators predict the severity and criticality of coronary lesions.Blood samples were obtained at the time of being inpatient.Plasma levels of HCY,uric acid,Cystatin C,total cholesterol,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol were measured by clinical laboratory.Chi square test was used for analysis of categorical variables,and continuous variables were analysed with student's t-test,and correlation analysis between the two variables using Pearson correlation analysis to explore the relationship between plasma HCY levels and the severity and criticality.Result1.The level of homocysteine in vulnerable plaque group,stable plaque group and control group was(25.3 ±5.8)umol/L,(20.3 ±4.7)umol/L,(11.5±2.6)umol/L,The analysis of variance showed that the differences between any two groups were significant.2.The level of homocysteine in single branch lesion group,double branch lesion group and three lesion group was(26.9 ± 5.0)umol/L,(22.7±4.3)umol/L,(18.1±4.7)umol/L,The analysis of variance showed that the differences between any two groups were significant.3.The linear correlation analysis showed that the blood homocysteine was related to the SYNTAX score in patients with coronary heart disease,and the correlation coefficient was 0.476.4.The levels of uric acid,cystatin C,total cholesterol and low density lipoprotein in the vulnerable plaque group,the stable plaque group and the control group are decreasing in turn,and the analysis of variance showed that the differences between any two groups were significant.The high density lipoprotein level in the vulnerable plaque group,the stable plaque group and the control group is becoming higher,and the analysis of variance showed that the differences between any two groups were significant.5.The level of homocysteine in patients with hypertension was higher than that in patients without hypertension,and there was statistical difference between them.The level of homocysteine in patients with diabetes was higher than that in patients with non-diabetes,but there was no significant difference between them.Conclusion1.The serum homocysteine level in the vulnerable plaque group,the stable plaque group and the control group was increased in turn,which could reflect that the serum homocysteine is he risk factors of coronary heart disease.2.The serum homocysteine level in patients with coronary heart disease increased with the increase of coronary artery stenosis branches,and there was a positive correlation between serum homocysteine level and SYNTAX score.The higher the level of homocysteine was,the higher the level of homocysteine was.The higher the risk of coronary artery stenosis,the greater the degree and risk of coronary artery disease.3.The uric acid,cystatin C,total cholesterol,low density lipoprotein cholesterol are the risk factors of coronary heart disease,participate in the occurrence and development of coronary heart disease,the high density lipoprotein cholesterol is the protective factor of coronary heart disease.4.Homocysteine may play an important role in the formation and development of coronary atherosclerotic plaque through H type hypertension.