血清尿酸、同型半胱氨酸、白细胞介素-6与冠心病患者肠道菌群和主要不良心血管事件的关系研究

摘要 目的：研究血清尿酸（UA）、同型半胱氨酸（Hcy）、白细胞介素-6（IL-6）与冠心病患者肠道菌群和主要不良心血管事件（MACE）的关系。方法：选取2018年5月~2020年12月期间在中国人民解放军联勤保障部队第九八九医院行经皮冠状动脉介入术（PCI）的冠心病患者120例作为冠心病组，选取同期来中国人民解放军联勤保障部队第九八九医院体检的健康志愿者80例作为对照组。对比对照组、冠心病组的血清IL-6、Hcy、UA水平和乳酸杆菌、双歧杆菌、大肠杆菌。Pearson相关性分析IL-6、Hcy、UA和乳酸杆菌、双歧杆菌、大肠杆菌的相关性。记录冠心病组PCI术后随访1年MACE的发生率，并采用多因素Logistic回归分析MACE发生的影响因素。结果：冠心病组的血清IL-6、Hcy、UA水平高于对照组（P<0.05）。冠心病组的乳酸杆菌、双歧杆菌、大肠杆菌数量少于对照组（P<0.05）。Pearson相关性分析结果显示，IL-6、Hcy、UA均与乳酸杆菌、双歧杆菌、大肠杆菌呈负相关（P<0.05）。所有患者均完成随访，无失访患者。随访过程中发现有32例患者发生MACE，发生率为26.67%。根据是否发生MACE分为MACE组（n=32）和无MACE组（n=88）。单因素分析结果显示，MACE的发生与病程、吸烟史、合并高血压、合并糖尿病、置入支架数目、IL-6、Hcy、UA、乳酸杆菌、双歧杆菌、大肠杆菌有关（P<0.05）。多因素Logistic回归分析结果显示：病程偏长、吸烟史、合并高血压、合并糖尿病、置入支架数目更多、IL-6偏高、Hcy偏高、UA偏高是冠心病患者MACE发生的危险因素（P<0.05）。结论：冠心病患者体内IL-6、Hcy、UA水平升高，肠道菌群紊乱，且肠道菌群紊乱与IL-6、Hcy、UA水平相关。此外，冠心病PCI术后MACE发生不可避免，且受到病程、吸烟史、合并高血压等多种因素的影响。

Relationship Study between Serum Uric Acid, Homocysteine, Interleukin-6 and Intestinal Flora and Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease

ABSTRACT Objective: To study the relationship between serum uric acid (UA), homocysteine (Hcy), interleukin-6 (IL-6) and intestinal flora and major adverse cardiovascular events (MACE) in patients with coronary heart disease. Methods: 120 patients with coronary heart disease who underwent percutaneous coronary intervention (PCI) in the 989 Hospital of Joint Logistics Support Force of Chinese People''s Liberation Army from May 2018 to December 2020 were selected as the coronary heart disease group, and 80 healthy volunteers who came to the 989 Hospital of Joint Logistics Support Force of Chinese People''s Liberation Army for physical examination in the same period were selected as the control group. The levels of serum IL-6, Hcy, UA, Lactobacillus, Bifidobacterium and Escherichia coli in the control group and coronary heart disease group were compared. Pearson correlation analysis the correlation between IL-6, Hcy, UA and Lactobacillus, Bifidobacterium and Escherichia coli. The incidence of MACE in coronary heart disease group after PCI was recorded, and the influencing factors of MACE occurrence were analyzed by multivariate Logistic regression. Results: The levels of serum IL-6, Hcy and UA in coronary heart disease group were higher than those in control group (P<0.05). The number of Lactobacillus, Bifidobacterium and Escherichia coli in coronary heart disease group were less than those in control group (P<0.05). Pearson correlation analysis showed that IL-6, Hcy and UA were negatively correlated with Lactobacillus, Bifidobacterium and Escherichia coli (P<0.05). All patients completed the follow-up, and there were no lost patients. During the follow-up, 32 patients were found to have MACE, with an incidence of 26.67%. According to the occurrence of MACE, they were divided into MACE group (n=32) and non MACE group (n=88). Univariate analysis showed that MACE was related to the course of disease, smoking history, complicated with hypertension, complicated with diabetes, the number of stents placed, IL-6, Hcy, UA, Lactobacillus, Bifidobacterium and Escherichia coli (P<0.05). The results of multivariate Logistic regression analysis showed that the risk factors for MACE in patients with coronary heart disease were longer course of disease, smoking history, complicated with hypertension, complicated with diabetes, more number of stents placed, higher IL-6, higher Hcy and higher UA (P<0.05). Conclusion: The levels of IL-6, Hcy and UA in patients with coronary heart disease increased, and the intestinal flora are disordered, and the intestinal flora disorder are related to the levels of IL-6, Hcy and UA. In addition, MACE after PCI is inevitable, and which is affected by many factors, such as course of disease, smoking history, complicated with hypertension and so on.