H型高血压患者基因型与叶酸补充治疗的相关性

Correlation between genotypes and folic acid supplementation in patients with H-type hypertension

目的探讨不同基因型H型高血压患者血压及血浆同型半胱氨酸(homocysteine,Hcy)水平有无差异;在充分应用降压药物控制血压的同时给予叶酸补充治疗,观察治疗前后血浆Hcy及血压水平变化有无差异。方法通过Hcy检测确诊为H型高血压的患者166例入选。叶酸补充治疗前测定血浆Hcy水平,采集既往史、历史最高血压水平等,并行MTHFR(亚甲基四氢叶酸还原酶)677C/T基因型检测,根据检测结果进行分组,为CC组(野生型)、CT组(杂合型)、TT组(突变型)。所有患者在原有降压方案的基础上加用叶酸片0.8 mg 1/日,3月后测定患者血浆Hcy及血压水平。结果 1MTHFR 677C/T基因型检测结果:其中CC型42例,占25.3%,CT型42例,占25.3%,TT型82例,占49.6%。2叶酸治疗前血浆Hcy水平比较:男性高于女性,差异有统计学意义(P<0.05);TT组高于CC组及CT组,差异有统计学意义(P<0.05);CC组与CT组之间差异无统计学意义(P>0.05)。3历史最高血压水平比较:收缩压:CC组高于TT组,差异有统计学意义(P<0.05);CC组与CT组之间、CT组与TT组之间差异均无统计学意义(P>0.05);舒张压:3组之间差异均无统计学意义(P>0.05)。4叶酸补充治疗前后血浆Hcy水平比较:3组患者治疗后血浆Hcy水平均较治疗前降低,差异有统计学意义(P<0.05)。5叶酸补充治疗前后血浆Hcy差值比较:TT组高于CC组及CT组,差异有统计学意义(P<0.05),CC组与CT组间差异无统计学意义。6叶酸补充治疗前后血压差值比较分析:收缩压:CC组高于TT组,差异有统计学意义(P<0.05);CC组与CT组之间、CT组与TT组之间差异均无统计学意义(P>0.05);舒张压:三组之间差异均无统计学意义(P>0.05)。结论 H型高血压患者基因型与血浆Hcy及历史最高血压水平部分存在差异性。叶酸补充治疗能够有效降低H型高血压患者血浆Hcy水平,并且对MTHFR 677C/T TT可能具有更好的降低Hcy的效果。降压药物联合叶酸补充治疗可能能够更有效地降低MTHFR 677C/T CC基因型H型高血压患者血压水平。

Objective To investigate the difference in blood pressure （BP） and level of plasma homocysteine （Hcy） in patients with H-type hypertension and different genotypes, and observe the changes of Hcy and BP after controlling BP and folic acid supplementation. Methods The patients （n=166） were chosen after diagnosed as H-type hypertension through Hcy detection. The level of plasma Hcy was detected before folic acid supplementation and data about past medical history and the highest historical BP level were collected. The patients were given MTHFR 677C/T genotyping and divided into groups according the results, including CC group （wild type）, CT group （hybrid type） and TT （mutant type） group. All patients were given folic acid tables （0.8 mg/d） based on original BP control therapy, and after 3 m the levels of Hcy and BP were detected. Results ①The detective results of MTHFR 677C/T genotyping showed that there were 42 cases with CC type （25.3%）, 42 cases with CT type （25.3%） and 82 cases with TT type （49.6%）. ②Comparison in Hcy level before folic acid supplementation showed that Hcy level was higher in male cases than that in female ones （P〈0.05）, was higher in TT group than that in CC group and CT group （P〈0.05）, and had no statistical difference between CC group and CT group （P〉0.05）. ③Comparison in the highest historical BP level showed that systolic blood pressure （SBP） was higher in CC group than that in TT group （P〈0.05）, and had no statistical difference between CC group and CT group or between CT group and TT group （P〉0.05）, and diastolic blood pressure （DBP） had no statistical difference among 3 groups （P〉0.05）.④Comparison in Hcy level before and after folic acid supplementation showed that Hcy level decreased in 3 groups after folic acid supplementation （P〈0.05）. ⑤Comparison in difference of Hcy level before and after folic acid supplementation showed that Hcy level was higher in TT group than that in CC group and CT group （P〈0.05）, but there was no statistical difference between CC group and CT group. ⑥Comparison in difference of BP level before and after folic acid supplementation showed that SBP was higher in CC group than that in TT group （P〈0.05）, and there was no statistical difference between CC group and CT group or between CT group and TT group （P〉0.05）. There was no statistical difference in DBP among 3 groups （P〉0.05）. Conclusion There is difference between genotypes and Hcy level and the highest historical BP level in patients with H-type hypertension. Folic acid supplementation can effectively reduce Hcy level, and may have better effect on TT genotype of MTHFR 677C/T. Anti-hypertension drugs combining folic acid supplementation can more effectively reduce BP level in patients with H-type hypertension and CC genotype of MTHFR 677C/T.