儿童血浆同型半胱氨酸水平与原发性高血压相关性研究

The relationship between plasma homocysteine levels and essential hypertension in children

目的了解儿童血浆同型半胱氨酸水平，分析其与儿童原发性高血压的相关性。方法2004-2006年对北京3～18岁儿童和青少年2万余人进行了血压、血糖、血脂及肥胖的流行病学抽样调查。本研究随机抽取其中6～10岁原发性高血压儿童，男女各20例，另选学校体检血压正常的相应年龄段的男女儿童各20例作为对照组。两组儿童均经临床病史、体检、实验室检查除外其它心肺、泌尿、内分泌等疾病。采用高效液相色谱电化学内标法进行了血浆同型半胱氨酸水平测定。结果结果：男童高血压组与血压正常组收缩压分别为（119±9）mmHg、（102±5）mmHg（P〈0.001），舒张压分别为（76±6）mmHg、（66±6）mmHg（P〈0．001）；女重高血压组与血压正常组收缩压分别为（118±7）mmHg、（101±7）mmHg（P〈0.001），舒张压分别为（76±10）mmHg、（63±9）mmHg（P〈0.001）；本研究6～10岁血压正常儿童血浆同型半胱氨酸几何均值为（8.5±1.3）μmol/L，其中男童为（8．0±1．3）μmol/L，女童为（9．1±1．3）μmol／L，二者差异无统计学意义（P=0.126）。男女高血压组血浆同型半胱氨酸水平高于血压正常组，男童分别为（10．2±1.5）μmol/L、（8，0±1．3）μmol/L，P=0．024；女童分别为（12.2±1.5）μmoL/L、（9．1±1.3）μmol／L，P=0.008。控制性别，血浆同型半胱氨酸水平与年龄呈正相关（r=0.31，P=0.006），控制年龄、性别，血浆同型半胱氨酸水平与收缩压和舒张压均呈正相关，与BMI、血糖，甘油三酯及总胆固醇无明显相关性。进一步控制BMI、血糖、甘油三酯及总胆固醇，同型半胱氨酸与收缩压和舒张压的正相关关系依然存在，偏相关系数分别为（r=0.265，P=0．024）和（r=0．347，P=0.003）。结论儿童血浆同型半胱氨酸水平与血压正相关，高血压儿童血浆同型半胱氨酸水平高于血压正常的同龄儿童。

Objective Elevated total homocysteine is an important risk factor for cardiovascular and cerebrovascular disease in adults. While its association with essential hypertension in children is seldom documented. The objective of this study is to analyze the relationship between plasma homocysteine levels and essential hypertension in children. Methods Using the data acquired from epidemiology study of blood pressurel blood glucose, lipids and obesity in Beijing children and adolescent aged from 3 - 18 years in 2004-2006. 40 children with essential hypertension aged 6 - 10 years including 20 boys and 20 girls were randomly selected from it, and 20 boys and 20 girls in the same age category with norreal blood pressure in one local school were randomly selected as control. Medical history and physical examination were conducted for all the subjects to exclude the heart, pulmonary, urology and endocrine diseases. Their plasma homocysteine concentrations were measured by high performance liquid chromatographic with electrochemical detection method.Results For boys, systolic blood pressure in hypertensive group and normaltensive group were 119 ± 9 versus 102±5mmHg（ P 〈0. 001 ） , and diastolic blood pressure were 76 ±6mmHg versus 66± 6mmHg（ P 〈0. 001 ） ; for girls, systolic blood pressure in hypertensive group and normaltensive group were 118± 7mmHg versus 101± 7mmHg（ P 〈0. 001 ） ,and diastolic blood pressure were 76 ± 10mmHg versus 63 ± 9mmHg （ P 〈 0. 001 ）. In this study, homocysteine geometric mean level of children aged 6-10 years with nonnaltension was 8.5 ± 1.3μmol/L,and 8.0 ± 1.3μmol/L in boys and 9.1 ± 1.3μmol/L in girls, no sex difference was observed（ P = 0. 126）. Plasma homocystein levels were significantly higher in children with essential hypertension than in those with normaltension. Homocysteine geometric mean level in hypertensive children and in normaltensive children were 10. 2 ± 1.5 μmol/L and 8.0 ± 1.3μmol/L respectively for boys （ P = 0. 024 ） ; and 12. 2 ± 1.5 μmol/L and 9. 1 ± 1.3μmol/L respectively for girls （ P = 0. 008 ）. There was a positive relationship between homocysteine levels and age（ r =0. 31, P =0. 006） after sex controlled. Controlling for sex and age, homocysteine levels were positively related with both systolic and diastolic blood pressure, while no significant relations were observed with BMI, blood glucose, triglyceride and total cholesterol. The positive relationship between homocysteine levels and systolic and diastolic blood pressure still existed after all above factors being controlled, the partial coefficients were 0. 265 （ P = 0. 024） for systolic blood pressure and 0. 347 （ P = 0. 003 ） for diastolic blood pressure, respectively. Conclusion Plasma homocysteine levels were positively related with blood pressure, and children with essential hypertension had higher homocystein levels than those with normaltension.