老年人高同型半胱氨酸高血压与不稳定型心绞痛的关系

The relationship between H-type hypertension and unstable angina in the elderly

目的探讨老年人高同型半胱氨酸（Hey）高血压（H型高血压）与不稳定型心绞痛（UA）的关系。方法收集2010年10月至2011年10月齐齐哈尔医学院附属第三医院心内科住院的符合入选标准的老年原发性高血压合并心绞痛患者147例，Hcy水平≥10μmol／L为老年H型高血压组72例，Hcy水平〈10μmol／L为老年单纯高血压组75例；所有患者均行冠状动脉造影检查，用酶法测定Hcy水平，比较血清Hcy水平的差异。结果H型高血压组与单纯高血压组UA发生率[44．4％（32／72）与12．0％（9／75）]、冠状动脉病变积分[（44．2±21.3）分与（31．9±18．4）分]、高敏c反应蛋白水平hsCRP，（4．3±2．1）与（2．0±1．9）μg／L]比较，差异有统计学意义（均P〈0．01）；H型高血压组中血清Hcy的水平在UA发作期与缓解期比较[（22．2±7．1）与（13．74-3．7）μmol／L]、uA发作期与稳定型心绞痛（sA）组比较[（22．2±7．1）与（12．0±4．2）μmol／L3，差异有统计学意义（均P〈0．01）。单纯高血压组中uA患者的血清Hcy水平高于sA患者[（8．9±2．2）与（6．6±1．2）btmol／L，P〈0．013，且uA患者的血清总胆固醇水平高于sA患者[（6．9±0．7）与（4．5±0．5）mmol／L，P〈O．013，血清低密度脂蛋白胆固醇水平高于SA患者[（4．6土0．8）与（2．7±0．6）mmol／L，P〈0．01]。多元线性逐步回归分析结果显示，老年H型高血压是UA的独立影响因素（OR=5．691，P〈0．01）。结论老年人H型高血压与UA密切相关，是老年人UA独立危险因素。血浆Hcy水平与冠状动脉粥样斑块稳定性和冠状动脉病变严重程度相关。

Objective To investigate the relationship between H-type hypertension and unstable angina （UA）. Methods Totally 147 elderly inpatients with hypertension and angina in our hospital were selected. Patients were divided into H-type hypertension group [n= 72, serum homocysteine （Hcy） level 10μmol/L ] and primary hypertension group [ n=75, serum homocysteine （Hcy） level 〈10μmol/L]. All patients underwent coronary angiography. Serum Hcy level was measured by enzyme method and compared between groups. Results There were statistical differences in the UA incidence, Gensini＇s score and high sensitive C-reactive protein（hsCRP） level between the H-type hypertension group and primary hypertension group [ （44.4% （32/72） vs. 12.0%（9/75）, （44.2±21.3） vs. （31.9±18.4）, （4.3 ± 2.1） μg/L vs. （2.0±1.9） μg/L, respectively, all P〈0.01]. Serum Hcy level in H-type hypertension group was higher during UA attack than during UA remission [（22. 2527.1）tLmol/L vs. （13. 7±3.7）txmol/L, P〈 0. 013. Serum Hey level during UA attack was increased in H-type hypertension group than in stable angina group （（22. 2±7.1）μmol/L vs. （12.0±4.2）μmol/L, P 〈 0. 013. Serum levels of Hey, total cholesterol and low density lipoprotein cholesterol in primary hypertension group were higher in UA patients than in stable angina patients （（8.9±2.2）tzmol/L vs. （6.6±1.2）/zmol/L, （6.9±0.7）mmol/L vs. （4.5±0.5）mmol/L, （4.6±0.8）mmol/L vs. （2.7 ± 0.6） mmol/L, respectively, P〈 0.01 or P〈0. 053. Logistic regression analysis showed that H-type hypertension was the independent risk factor for unstable angina in the elderly （OR- 5. 691, P〈 0.01）. Conclusions H-type hypertension is closely correlated with unstable angina, which is the independent risk factor for unstable angina in the elderly. Serum Hcy level has significant correlation with coronary atherosclerotic plaque stability and the severity of coronary artery disease.