高血压患者伴高同型半胱氨酸血症与脑动脉狭窄程度的相关性

Correlation between hypertension accompanying homocysteinemia and cerebral artery stenosis

目的探讨高血压患者伴高同型半胱氨酸(Hcy)血症与脑大动脉狭窄程度的相关性。方法选择行全脑数字减影血管造影术(DSA)检查的急性缺血性脑卒中患者269例。根据DSA显示动脉狭窄是否≥50%为依据,分为2组:狭窄组150例,患者颅内、外脑大动脉至少1支血管狭窄率≥50%;对照组119例,患者无狭窄或狭窄<50%。检测2组血浆Hcy水平及血压变化,并将所有入选的患者分为Hcy和血压均正常者(1组)、单纯Hcy升高者(2组)、单纯高血压者(3组)、高血压伴高同型半胱氨酸血症者(4组),观察血管狭窄≥50%的发生率。结果狭窄组Hcy和收缩压水平明显高于对照组[(15.5±4.9)μmol/L vs(14.2±4.0)μmol/L,(154.1±22.9)mm Hg vs(145.6±25.6)mm Hg(1 mm Hg=0.133 kPa)]。4组脑动脉狭窄≥50%的发生率最高(P<0.05);3组和4组脑动脉狭窄≥50%的发生率比1组和2组明显增高(P<0.05);2组与1组比较差异无统计学意义(P>0.05)。结论 Hcy升高及高血压均与脑动脉狭窄程度密切相关,二者共同存在时脑动脉狭窄≥50%的发生率显著增加,其协同作用以高血压为主要因素。

Objective To study the correlation between hypertension accompanying homocysteine- mia and large cerebral artery stenosis in hypertensive patients. Methods Two hundred and sixty- nine ischemic stroke patients undergoing cerebral angiography（DSA） were divided into stenosis group（n=150） with the stenosis≥50% in at least one large cerebral artery and control group（n= 119） with no cerebral artery stenosis or with the stenosis〈50%. Their plasma homocysteine （Hcy） level and blood pressure were measured. The patients,enrolled in this study,were further divided into normal Hcy and blood pressure group（group 1）, simple high Hcy group（group 2）, simple high blood pressure group （group 3）, and hypertension accompanying homocysteinemia group（group 4）. The incidence of artery senosis^50~ was observed in them. Results The Hcy level and blood pressure were significantly higher in stenosis group than in control group（15.5-＋- 4.9 /~mol/L vs 14.2_＋4.0 t^mol/L,154.1-＋-22.9 mm Hg vs 145.6-25.6 mm Hg,P〈0.05）. The incidence of cerebral artery stenosis≥50% was significantly higher in groups 3 and 4 than in groups 1 and 2（P〈0.05） with no significant difference observed between groups 1 and 2 （P〈 0.05）. Conclusion Elevated Hcy and hypertension are closely related with cerebral artery steno- sis. The incidence of cerebral artery stenosis≥50 % increases significantly when both Hcy and hy- pertension are present. Their synergistic effect is the main risk factor for hypertension.