H型高血压与急性冠脉综合征发病相关性及同型半胱氨酸水平研究

Association between H Type Hypertension and Acute Coronary Syndrome and Homocysteine Study

目的探讨H型高血压与急性冠脉综合征(ACS)的相关性。方法收集2011年10月—2012年10月于齐齐哈尔医学院附属第三医院心内科入院的符合入选标准的原发性高血压病合并冠心病患者294例,其中同型半胱氨酸(Hcy)水平≥10μmol/L为H型高血压患者(144例),归为研究组;Hcy水平<10μmol/L为单纯高血压患者(150例),归为对照组。所有患者均行冠脉造影检查,采用酶法测定Hcy水平,比较血清Hcy水平的差异。结果研究组ACS发生率、冠状动脉病变积分与对照组比较,差异有统计学意义(P<0.05)。研究组中ACS患者的血清Hcy水平高于非ACS患者〔(22.18±7.13)比(11.97±4.17)μmol/L〕,差异有统计学意义(P<0.01)。对照组中ACS患者的血清Hcy水平低于非ACS患者〔(6.58±1.21)比(8.86±2.18)μmol/L〕,血清总胆固醇水平〔(6.93±0.72)比(4.54±0.51)mmol/L〕、低密度脂蛋白胆固醇水平〔(4.58±0.83)比(2.69±0.57)mmol/L〕高于非ACS患者,差异均有统计学意义(P<0.05)。多元Logistic回归分析显示,H型高血压是ACS的独立危险因素〔OR=4.675,95%CI(2.614,12.393),P<0.01〕;Hcy也是其危险因素〔OR=1.226,95%CI(1.060,1.418),P<0.01〕。结论 H型高血压与ACS密切相关,是ACS的独立危险因素,并且与血脂无相关性。血浆Hcy水平与冠脉病变严重程度相关。

Objective To investigate the association between H type hypertension and acute coronary syndrome(ACS).Methods We selected according to the inclusion criteria 294 inpatients with primary hypertension and coronary heart disease in the Cardiology Department of the Third Affiliated Hospital of Qiqihaer Medical College between October 2011 and October 2012.They were divided into an H group 〔homocysteine(Hcy) ≥10 μmol/ L;n = 144〕and a control group(Hcy < 10 μmol/ L;n = 150).All the patients underwent coronary angiography.The Hcy levels were determined using immuno assay and compared.Results The number of ACS cases and Gensini score in the H group were significantly different from that of the control group(P < 0.05).The serum Hcy level of the ACS patients was higher than that of non-ACS patients 〔(22.18 ± 7.13) vs.(11.97 ± 4.17) μmol/ L,P < 0.01 〕in the H group.The ACS patients of the control group had lower serum Hcy level 〔(6.58 ±1.21) vs.(8.86 ± 2.18) μmol/L〕,but higher total cholesterol level 〔(6.93 ± 0.72) vs.(4.54 ± 0.51) mmol/ L〕and low density lipoprotein cholesterol level 〔(4.58 ± 0.83) vs.(2.69 ± 0.57) mmol/ L〕than non-ACS patients of the group(P < 0.05).Logistic regression analysis results showed H type hyper tension and Hcy were independent risk factors for ACS〔OR = 4.675,95% CI(2.614,12.393);OR = 1.226,95% CI(1.060,1.418);P < 0.01〕.Conclusion H type hypertension is closely correlated with ACS and might be an independent risk factor for ACS.However,H type hypertension is not correlated with blood lipid.Hcy level is significantly associated with the severity of coronary artery disease.