1 成都市龙泉驿区第一人民医院心内科，成都 610100
2 四川大学华西医院心内科，成都 610041
目的：探讨缺血性心肌病(ischemic cardiomyopathy，ICM)患者血清D-二聚体(D-dimer，DD)、同型半胱氨酸(homocysteine，HCY)与左心室重构的关系，旨在为ICM左心室重构的早期诊断提供参考。方法：选择2016年6月至2019年6月成都市龙泉驿区第一人民医院收治的130例ICM患者为研究对象，依据冠状动脉造影结果将ICM患者分为重构组(左心室重构，n=95)和无重构组(无左心室重构，n=35)，比较ICM不同心功能分级患者血清DD和HCY水平，左心室重构参数[左心室舒张末期内径(left ventricular end-diastolic diameter，LVEDd)，左心室后壁厚度(left ventricular posterior wall thickness，LVPW)，左心室射血分数(left ventricular ejection fraction，LVEF)]。采用单因素、二元logistic回归分析ICM患者左心室重构的影响因素，Pearson参数分析ICM患者血清DD和HCY水平与左心室重构的相关性。结果：ICM患者心功能分级越高，血清DD和HCY水平越高，差异有统计学意义(P<0.05)；ICM患者心功能分级越高，LVEDd和LVPW越厚而LVEF越低。不同心功能分级患者LVEDd，LVPW和LVEF两两比较，差异有统计学意义(P<0.05)。血清DD(OR=1.102，95%CI：1.016~1.382)，HCY(OR=1.685，95%CI：1.009~2.798)水平是ICM患者左心室重构的危险因素(P<0.05)。ICM患者血清DD、HCY水平与LVEDd、LVPW呈明显正相关，而与LVEF呈明显负相关(r=0.502，0.518，−0.673；r=0.643，0.592，−0.687，P<0.05)。结论：ICM患者血清DD和HCY水平明显升高，LVEDd和LVPW显著增大而LVEF明显降低，且ICM患者血清DD和HCY水平与左心室重构参数呈明显相关性，DD和HCY水平与ICM病情程度密切相关。关键词： 缺血性心肌病；D-二聚体；同型半胱氨酸；左心室重构
Correlation between serum D-dimer, homocysteine and left ventricular remodeling parameters in patients with ischemic cardiomyopathy
CorrespondingAuthor: TUO Wei Email: email@example.com
Foundation: This work was supported by the Chengdu Medical Research Project, China (2018116).
remodeling in patients with ischemic cardiomyopathy (ICM), aiming to provide reference for early diagnosis of ICM left ventricular remodeling. Methods: One hundred and thirty patients with ICM who were admitted and treated at the hospital between June 2016 and June 2019 were selected as subjects. According to the results of coronary angiography, subjects were divided into a remodeling group (left ventricular remodeling, n=95) and a non-remodeling group (no left ventricular remodeling, n=35). The levels of serum DD and HCY, and left ventricular remodeling parameters [left ventricular end-diastolic diameter (LVEDd), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF)] were compared between patients with different grades of cardiac function. Univariate and binary regression analyses were performed to analyze influencing factors of left ventricular remodeling in patients with ICM. Pearson parameters were used to analyze the correlation between serum DD, HCY levels and left ventricular remodeling in patients with ICM. Results: For patients with ICM, the higher the cardiac function grading, the higher serum DD and HCY levels. The difference was statistically significant (P<0.05); the higher the cardiac function grading, the larger LVEDd and LVPW, and the lower LVEF. Differences in LVEDd, LVPW and LVEF of patients with different grades of cardiac function were statistically significant (P<0.05). Serum DD [odds ratio (OR)=1.102, 95% confidence interval (CI): 1.016 to 1.382] and HCY (OR=1.685, 95% CI: 1.009 to 2.798) levels were risk factors for left ventricular remodeling in patients with ICM (P<0.05). The levels of serum DD and HCY were significantly positively correlated with LVEDd and LVPW, but were significantly negatively correlated with LVEF in patients with ICM (r=0.502, 0.518, −0.673; r=0.643, 0.592, −0.687, P<0.05). Conclusion: Serum DD and HCY levels were significantly increased, LVEDd and LVPW were significantly increased and LVEF was significantly decreased in patients with ICM. Besides, serum DD and HCY levels were significantly correlated with left ventricular remodeling parameters in patients with ICM. DD and HCY levels are closely related to the severity of ICM.Keywords： ischemic cardiomyopathy; D-dimer; homocysteine; left ventricular remodeling