老年原发性高血压患者血同型半胱氨酸水平及颈动脉斑块在预测冠心病发病及严重度中的价值

Value of Serum Homocysteine Level and Carotid Artery Plaque for the Prediction and Severity Assessment of Coronary Heart Disease in Elderly Patients with Primary Hypertension

目的探讨老年原发性高血压患者血同型半胱氨酸(Hcy)水平及颈动脉斑块在预测冠心病发病及严重度中的价值。方法选择2009年2月至2013年2月上海浦东医院老年科收治的老年(>70岁)原发性高血压患者257例,根据有无高Hcy血症、颈动脉斑块分为4组:对照组(无高Hcy血症、无颈动脉斑块)(n=76),高Hcy组(仅伴高Hcy)(n=50),颈动脉斑块组(仅伴颈动脉斑块)(n=46),高Hcy血症合并颈动脉斑块组(同时伴高Hcy和颈动脉斑块)(n=85)。高Hcy血症合并颈动脉斑块组中血脂正常患者25例,血脂异常60例。比较各组并发冠心病的发生率及严重程度。结果高Hcy组冠心病、冠状动脉单支病变发生率(22.0%、16.0%)显著高于对照组(6.6%、4.0%)(P<0.05),颈动脉斑块组冠心病、冠状动脉单支病变及多支病变发生率(67.4%、39.1%、28.3%)均显著高于高Hcy组(6.6%、4.0%、2.6%)(P<0.05);高Hcy合并颈动脉斑块组冠心病、冠状动脉多支病变发生率(83.5%、50.6%)显著高于颈动脉斑块组(67.4%、28.3%)(P<0.05)。高血Hcy合并颈动脉斑块组中血脂异常组冠心病、冠状动脉多支病变发生率显著高于血脂正常组(93.3%比60.0%,63.3%比20.0%)(P<0.05)。结论对老年原发性高血压患者同时检测血清Hcy、血脂及超声检查颈动脉斑块对预测冠心病的发生有较大的临床价值。在技术设备不足的情况下,联合观察血清Hcy、血脂及颈动脉斑块可能是一个较好的方法。

Objective To investigate the value of serum homocysteine（ Hcy） level and carotid artery plaque for the prediction and severity assessment of coronary heart disease in elderly patients with primary hypertension,to provide the basis for clinical prevention and treatment. Methods A total of 257 elderly（ 70 years old） patients with primary hypertension admitted to department of geriatrics,Shanghai Pudong Hospital from Feb. 2009 to Feb. 2013 were included in the study and divided into control group（ without high Hcy hyperlipidemia and carotid plaque）（ n = 76）,high Hcy group（ only with high Hcy hyperlipidemia）（ n =50）,carotid artery plaque group（ only with carotid plaque）（ n = 46）,high Hcy associated with carotid artery plaque group（ with high Hcy hyperlipidemia and carotid plaque）（ n = 85） according to presence or absence of Hcy and carotid artery plaque. Among the patients in high Hcy associated with carotid artery plaque group there were 25 cases with normal serum lipid and 60 cases with dyslipidemia. The incidence and severity of coronary heart disease in each group were compared. Results The incidence of coronary artery disease and single vessel coronary artery pathological change in high Hcy group（ 22. 0%,16. 0%） were significantly higher than those in control group（ 6. 6%,4. 0%）（ P 0. 05）,the incidence of coronary artery disease,single and multivessel vessel coronary artery pathological change in carotid artery plaque group（ 67. 4%,39. 1%,28. 3%） were significantly higher than those in high Hcy group（ 6. 6%,4. 0%,2. 6%）（ P〈0. 05）; the incidence of coronary artery disease and multivessel vessel coronary artery pathological change in high Hcy associated with carotid artery plaque group（ 83. 5%,50. 6%） were significantly higher than those in carotid artery plaque group（ 67. 4%,28. 3%）（ P〈0. 05）. The incidence of coronary artery disease and multivessel vessel coronary artery pathological change of dyslipidemia group（ 93. 3%,63. 3%） were significantly higher than those of serum normal lipid group in high Hcy associated with carotid artery plaque group（ 60. 0%,20. 0%）（ P〈0. 05）. Conclusion Test of serum Hcy,blood lipid and carotid artery plaque by ultrasound examination in elderly patients with primary hypertension has great clinical value for prediction of coronary heart disease. In lack of technology and equipment,combined observation on serum Hcy,blood lipid and carotid artery plaque may be a good method.