| BackgroundCoronary heart disease(CHD)is one of the major problems facing the world.It is caused by a variety of causes.Traditional factors can not fully explain the pathogenesis of CHD.Nowadays,research on new risk factors such as uric acid and homocysteine(HCY)has gradually deepened.Homocysteine causes atherosclerosis mainly through several mechanisms,such as endothelial dysfunction,increased lipid accumulation and inflammatory cell permeability,oxidation of lipoprotein,vasculitis,smooth muscle proliferation,platelet activation and abnormal coagulation mechanism.Most of the studies have targeted men as the primary research object.With further understanding of the clinical features of coronary heart disease,the hospitalization rate and mortality rate of male CHD have decreased year by year,while the hospitalization rate and mortality rate of female CHD have not improved.And there is a trend of increasing year by year.Therefore,this study explores the impact of HCY on female CHD and related mechanisms by retrospectively collecting data and specimens from clinical data.ObjectiveThrough clinical case analysis,to explore that HCY is a risk factor for women with CHD and one of the indicators to assess the severity of the disease.It clarifies part of the mechanism of HCY affecting female coronary heart disease,and provides a theoretical basis for clinical prevention and treatment of female coronary heart disease.MethodsAccording to the results of coronary angiography,1249 patients with suspected coronary heart disease were divided into CHD group(780 cases)and control group(469cases).The age,sex,history of hypertension,history of diabetes mellitus,history of smoking and drinking were counted.The serum HCY,lipoprotein(a),[Lp(a)],total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL)were detected in each group.The serum HCY levels of LDL and GLU were analyzed according to sex groups,and the risk factors of CHD were analyzed by binary logistic regression model.According to the results of coronary angiography,128 female patients with CHD were divided into four groups according to Gensini score.The plasma levels of HCY,interleukin-1β(IL-1β)and vascular endothelial cell adhesion molecule-1(VCAM-1)were measured in each group,and the changes of HCY,IL-1βand VCAM-1 in each group were analyzed.Results1.The scores of diabetes mellitus,cerebral infarction history,HCY,Lp(a),TG,LDL,GLU and Gensini in CHD group were higher than those in control group(P<0.05).There was no significant difference in age,sex,hypertension,smoking history,TC and drinking history between CHD group and control group(P>0.05).2.The HCY of single vessel lesion group,double vessel lesion group and multiple vessel lesion group was higher than that of control group(P<0.05);the HCY,Lp(a),TC,TG,LDL and GLU of multiple vessel lesion group were higher than that of control group(P<0.05);the HDL of single vessel lesion group,double vessel lesion group and multiple vessel lesion group were lower than that of control group(P<0.05).3.According to Gensini score,HCY and TG in group B,C and D were higher than those in group A(P<0.05);HCY,Lp(a),TC,TG,LDL and GLU in group D were higher than those in group A(P<0.05);HDL in group B,C and D were lower than those in group A(P<0.05).4.Univariate logistic regression analysis showed that diabetes,history of cerebral infarction,HCY,Lp(a),TG,HDL,LDL had statistical significance(P<0.05),blood glucose had no statistical significance(P>0.05).Multivariate logistic regression analysis showed that diabetes,history of cerebral infarction,HCY,Lp(a),TG,LDL were risk factors for CHD,HDL was protective factor.Diabetes mellitus,history of cerebral infarction,HCY,Lp(a),TG and LDL were risk factors for female coronary heart disease(P<0.05).HCY was not a risk factor for male CHD.5.Pearson analysis showed that HCY concentration in female blood was positively correlated with Gensini score(P=0.003,r~2=0.1188).The levels of VCAM-1 and IL-1βin women increased with the increase of pathological changes(P<0.05).The concentrations of HCY,VCAM-1 and IL-1βin postmenopausal women were higher than those in pre-menopausal women(P<0.05).Conclusions1.Serum HCY level is positively correlated with the severity of coronary lesions,that is,the higher the HCY level,the more severe the severity of coronary lesions.HCY was an independent risk factor for women with CHD.2.The higher the degree of coronary artery lesion in women,the higher the levels of HCY,VCAM-1 and IL-1β.The plasma concentrations of VCAM-1 and IL-1βwere related to the occurrence of female coronary heart disease and the degree of coronary artery disease. |
