新型气体信号分子硫化氢与同型半胱氨酸在高血压患者中的变化探讨

Plasma hydrogen sulfide and homocysteine levels in hypertensive patients with different blood pressure levels and complications

目的分析高血压患者在不同血压水平、不同合并症时血浆硫化氢(H_2S)与同型半胱氨酸(HCY)的变化特点,探讨其在高血压中的作用。方法选择2004年门诊确诊的高血压患者165例,男性84例、女性81例,年龄30～75(59.81±10.60)岁。其中初发高血压患者28例,经治高血压患者137例。在经治高血压患者中,血压控制良好者38例、1级高血压者43例、2级以上高血压者56例。高血压合并冠心病者32例,合并脑卒中者42例。同时设立正常对照组32例,男性18例、女性14例。检测全部患者及对照组的血浆 H_2S 与 HCY 浓度。结果 (1)经治高血压组与正常血压组比较,存在高 HCY 血症(P<0.01)及低血浆 H_2S 浓度(P<0.05)。(2)与无冠心病的高血压组比较,合并冠心病的高血压患者中,血浆 HCY 浓度随着高血压病史的延长明显增高。(3)合并脑卒中的高血压患者的血浆 H_2S 浓度明显低于单纯高血压者(P<0.01);同时,脑卒中时间越长,患者的血浆 HCY浓度越高。(4)在经治高血压患者中,与血压控制良好者比较,血压控制不良即高血压水平>2级者存在低 H_2S 血浆浓度及高 HCY 血症(P<0.05,P<0.01)。结论高同型半胱氨酸血症作为新的危险因素,与新型气体信号分子 H_2S 共同对高血压的发生、发展起着重要作用。

Objective The present study was designed to observe the plasma concentrations of hydrogen sulfide （ H2S） and homocysteine （HCY） in hypertensive patients with different blood pressure levels and complications. Methods A total of 165 outpatients with essential hypertension were involved in this study （84 males, 81 females, mean age 59. 81 ± 10. 60 years old）. There were 28 new-onset untreated, 137 ever-treated patients. Among ever-treated patients, blood pressure was normal in 38, grade 1 hypertension in 43, grade 2 and 3 hypertension in 56 patients. Thirty-two patients were accompanied with coronary heart disease （CAD）, and 42 patients were accompanied with stroke. A total of 32 age- and sexmatched healthy controls （18 males ） were also recruited. Plasma H2S and HCY concentrations were determined in all patients and controls. Results （ 1 ） Plasma H2S levels were significantly lower （P 〈 0.05 ） and HCY levels were significantly higher （P 〈 0. 01 ） in ever-treated hypertensive patients compared with controls. （2） Plasma HCY levels were significantly higher in patients with hypertension history 〉 6 months and complicated with CAD compared to patients without CAD. （3） Plasma H2S concentrations in patients with stroke history 〉 5 years were significantly lower than that in patients without stroke （ P 〈 0.01 ） . Plasma HCY concentrations were increased in proportion to stroke history. （4）In ever-treated hypertensive patients, plasma H2 S concentrations in patients with grade 2 and 3 hypertension were significantly lower （P 〈0. 05） and HCY levels significantly higher （P 〈 0. 01 ） than that in patients with well-controlled blood pressure. Conclusion Hyperhomocysteinemia and the novel signaling gasotransmitter H2S might play important roles in the pathogenesis and development of hypertension.