原发性高血压患者血浆同型半胱氨酸水平的变化及相关性研究

Changes and correlation study of plasma homocysteine in patients with primary hypertension

目的了解原发性高血压患者血浆同型半胱氨酸(Hcy)水平,探讨其与传统心血管危险因素及亚临床靶器官损害之间的关系。方法收集106例原发性高血压患者的相关资料,依据《中国高血压防治指南》行超声心动图、颈动脉超声、估算的肾小球滤过率(iGFR)判断是否存在靶器官损伤(若患者同时存在2种或2种以上的靶器官损伤,则归入各组分别统计),将106例患者分为单纯高血压组(44例)、高血压伴左心室肥厚组(18例)、高血压伴颈动脉硬化组(46例)及高血压伴iGFR下降组(27例)。同时检测血浆Hcy、血糖(FPG)、血脂、血肌酐(Cr)等,并采用Spearman相关性分析及多元logistic回归对各组数据进行分析。结果 Hcy与各靶器官损害呈明显正相关(P<0.05),且与传统心血管危险因素[性别、年龄、吸烟、收缩压(SBP)、FPG、Cr]明显相关(P<0.05)。单纯高血压组血浆Hcy水平[(12.18±3.30)μmol/L]明显低于高血压伴iGFR下降组[(19.05±8.58)μmol/L]、高血压伴左心室肥厚组[(18.63±7.99)μmol/L]、高血压伴颈动脉硬化组[(16.80±6.34)μmol/L](P均<0.05)。高血压伴颈动脉硬化组年龄、Hcy、血糖、iGFR与单纯高血压组比较差异有统计学意义(P<0.05)。以有无颈动脉粥样硬化为因变量,年龄、血糖、iGFR和Hcy为自变量,通过多元logistic回归分析,结果表明仅有年龄是高血压患者颈动脉粥样硬化的独立危险因素。按美国心脏病协会制定的Hcy异常临界值标准(>15μmol/L)将Hcy区分为正常和升高,高血压伴Hcy升高者罹患颈动脉粥样硬化的风险比Hcy正常者高出2.74倍。结论年龄是高血压患者颈动脉粥样硬化的独立危险因素;Hcy升高与高血压患者亚临床靶器官损害密切相关,且罹患颈动脉粥样硬化的风险上升。

Objective To study the levels of plasma homocysteine （Hcy） in patients with primary hypertension, and to investigate the relationship of Hcy with cardiovascular risk factors and subclinical damage. Methods According to the echocardiogram, carotid artery ultrasonic inspection and isotope glomerular filtration rate （iGFR） Chinese Guidelines for the Management of Hypertension, the target damage was analyzed and evaluated （ if patients had 2 or more than 2 target damages, they were classified into the groups below and analyzed statistically）, and 106 primary hypertension patients were classified into the simple hypertension group （44 patients ）, the hypertension with left ventricular hypertrophy group （ 18 patients）, the hypertension with carotid atherosclerosis group （46 patients） and the hypertension with decreasing iGFR group （27 patients）. Plasma Hcy, fasting plasma glucose （FPG） , lipid and creatinine （Cr） were measured, and the results were compared and analyzed by Spearman correlation analysis and multi-logistic regression analysis. Results Hcy was positively correlated with subclinical damage and some traditional cardiovascular risk factors [ sex, age, smoking, systolic blood pressure （ SBP）, FPG and Cr （ P 〈 0. 05 ）. The Hcy levels of the simple hypertension group [ （12.18 ± 3.30 ） μmol/L] were lower than those of the hypertension with decreasing iGFR group [ （ 19.05 ± 8.58） μmol/L], the hypertension with left ventricular hypertrophy group [ （ 18.63 ± 7.99） μmol/L] and the hypertension with carotid atherosclerosis group [ （16.80 ±6.34） μmo]/L] （P 〈0.05）. Age,Hcy, FPG and iGFR had statistical significance between the simple hypertension group and the hypertension with carotid atherosclerosis group （ P 〈 O. 05 ）. Non-carotid atherosclerosis was as dependent variable, and age, FPG, iGFR and Hcy were as independent variables. Multi-logistic regression analysis showed that age was independently associated with carotid athcrosclerosis. If only defiaed Hcy as normal and increasiag with the abnormal cut-off value of Hcy 〉 15 ~moLZL according to the American Heart Association, the risk of carotid atherosclerosis in hypertension patients with increasing Hcy was 2.74 times higher than than in subjects with normal Hcy. Conclusions Age is an important independent risk factor for carotid atherosclerosis in primary hypertension patients. The increasing of Hcy is closely related with subclinical damage, and has a high risk for carotid atherosclerosis.