老年高血压患者Hcy水平、MTHFR C677T基因型及补充叶酸对降压效果和靶器官损害的影响研究

Effects of Hcy levels,MTHFR C677T genotype,and folic acid supplementation on antihypertensive efficacy and target organ damage in elderly hypertensive patients

目的探讨老年高血压患者同型半胱氨酸(homocysteine,Hcy)水平、MTHFR C677T基因型及补充叶酸对降压效果和靶器官损害的影响。方法选取2019年1月~2022年12月于南京鼓楼医院集团宿迁医院诊断为原发性H型高血压患者190例作为研究对象,随机分为两组(每组各95例):对照组为依那普利+常规降压药组,观察组为依那普利叶酸片+常规降压药组。检测两组患者治疗前后的叶酸水平,颈动脉斑块积分及不稳定率,左心室后壁、室间隔厚度,肌酐清除率及24 h尿微量白蛋白,并比较不同基因型对叶酸干预的效果。结果观察组的降压效果和对靶器官的保护效果均优于对照组,血压控制更稳定,左心室后壁和室间隔厚度的增厚较小,颈动脉斑块积分和不稳定率降低,肌酐清除率更高,24 h尿微量白蛋白更低,同时Hcy水平显著降低,而且叶酸水平明显提高,以上差异均具有统计学意义(P<0.05);不同基因型高血压患者在叶酸治疗后,肌酐清除率提升,24 h尿微量白蛋白减少,且显著降低Hcy水平和血压水平;且TT型患者对叶酸干预在降低Hcy水平、血压水平上有更好的效果。结论在降压治疗中,依那普利叶酸片配合常规降压药治疗能更好地降低Hcy水平,改善靶器官损害,且TT基因型患者对于叶酸干预效果和血压水平的影响更为显著。

Objective To explore the effects of homocysteine(Hcy)levels,MTHFR C677T genotype,and folic acid supplementation on antihypertensive efficacy and target organ damage in elderly hypertensive patients.Methods A total of 190 patients with primary H-type hypertension diagnosed at our hospital from January 2019 to December 2022 were selected and randomly divided into two groups(95 cases in each group):the control group was treated with enalapril and conventional antihypertensive drugs,and the observation group was treated with enalapril folate tablets and conventional antihypertensive drugs.The folate levels of two groups of patients before and after treatment,carotid artery plaque score and instability rate,left ventricular posterior wall and interventricular septal thickness,creatinine clearance rate and 24 h urine microalbumin were detected,and the effects of different genotypes on folic acid intervention was compared.Results The observation group had better antihypertensive effect and protective effect on target organs than the control group,with more stable blood pressure control,less thickening of left ventricular posterior wall and interventricular septum thickness,reduced carotid plaque integral and instability rate,higher creatinine clearance rate,lower 24 h urine microalbumin,and significantly reduced Hcy level,and significantly increased folate level.The above differences were statistically significant(P<0.05);After folic acid treatment,patients with different genotypes of hypertension showed an increase in creatinine clearance and a decrease in 24 h urinary microalbumin.Moreover,folic acid intervention significantly reduced Hcy and blood pressure levels.TT type folic acid intervention had better effects in reducing Hcy levels and blood pressure reduction.Conclusion In antihypertensive treatment,enalapril folate tablets combined with conventional antihypertensive drugs can better reduce Hcy levels and improve target organ damage.TT genotype has a better effect on folate intervention,and its impact on blood pressure levels is also more significant.