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目的:观察不稳定型心绞痛(UAP)患者经皮冠状动脉介入治疗(PCI)后早期并发症的发生情况,检测术前同型半胱氨酸(Hcy)水平及PCI前、术后v WF、白细胞介素-8(IL-8)、一氧化碳(NO)水平,探讨Hcy与PCI早期并发症的关系及可能的作用机制。方法:选择88例行PCI UAP患者,分别于术前、术后30min、4h、12h、24h、48h、72h、7d取外周静脉血,采用酶联免疫吸附双抗夹心法测定Hcy、v WF、IL-8,利用硝酸还原酶法测定NO。结果:88例患者PCI术后心脏早期并发症总发生率为12·5%。早期并发症组患者术前Hcy、v WF和IL-8水平显著高于非早期并发症组(均P<0·05),NO水平显著低于非早期并发症组(P<0·05)。早期并发症组患者术后v WF和IL-8峰值水平显著高于无早期并发症组(均P<0·05),术后NO最低值低于非早期并发症组,但两者相比差异无统计学意义(P>0·05)。Hcy水平与v WF、IL-8术前、术后峰值水平呈正相关(r=0·634,P<0·01;r=0·534,P<0·01;r=0·597,P<0·01;r=0·544,P<0·01),与NO术前、术后低值水平呈负相关(r=-0·568,P<0·01、r=-0·148,P>0·05)。多变量Logistic回归分析,术前Hcy水平(RR=1·225,CI=1·059-1·418,P<0·01),糖尿病(RR=1·712,CI=1·128-2·898,P<0·05)是PCI早期并发症的独立预测因子。结论:①Hcy水平与PCI术后早期并发症密切相关,随着Hcy水平升高,早期并发症有显著增高趋势。②血浆Hcy可能通过影响IL-8、v WF水平导致早期并发症的出现。③Hcy水平对PCI术后早期并发症具有独立预测价值。
Objective: To observe the incidence of early complications after percutaneous coronary intervention (PCI) in patients with unstable angina pectoris (UAP), and to detect the preoperative level of homocysteine (Hcy) and the levels of vWF, leukocyte (IL-8) and nitric oxide (NO) levels in patients with early-stage PCI and to explore the relationship between Hcy and early complications of PCI and its possible mechanism. Methods: Eighty-eight patients with PCI UAP were enrolled in this study. Peripheral venous blood was collected before operation, 30min, 4h, 12h, 24h, 48h, 72h and 7d after operation. Hcy and vWF were measured by enzyme linked immunosorbent assay (ELISA) IL-8, nitric acid reductase method for the determination of NO. Results: The total incidence of early cardiac complications in 88 patients after PCI was 12.5%. The preoperative levels of Hcy, v WF and IL-8 in patients with early complications were significantly higher than those without early complications (all P <0.05), and the levels of NO in patients with early complications were significantly lower than those without complications (P <0.05) . The peak levels of vWF and IL-8 in patients with early complications were significantly higher than those without early complications (all P <0.05), and the lowest postoperative NO levels were lower than those without early complications The difference was not statistically significant (P> 0.05). Hcy levels were positively correlated with preoperative and postoperative peak levels of vWF and IL-8 (r = 0.634, P <0.01; r = 0.543, P <0.01; <0.01, r = 0.5444, P <0.01), which was negatively correlated with preoperative and postoperative NO levels (r = -0.568, P <0.01, r = -0 · 148, P> 0.05). Multivariate Logistic regression analysis showed that preoperative Hcy levels (RR = 1.2525, CI = 1.059-1.418, P <0.01), diabetes (RR = 1. 712, CI = 1.128-2 · 898, P <0.05) was an independent predictor of early PCI complications. Conclusions: ① The level of Hcy is closely related to the early complications after PCI. As the level of Hcy increases, the early complications are significantly increased. ② Plasma Hcy may lead to early complications by affecting IL-8, v WF levels. ③Hcy levels have independent predictive value for the early postoperative complications of PCI.