高血压患者颈动脉粥样硬化与同型半胱氨酸的相关性研究

Correlation between Carotid Atherosclerosis and Homocysteine Levels in Patients with Hypertension:A Cross-sectional Study

目的研究高血压患者颈动脉粥样硬化与同型半胱氨酸相关性及其城乡差异。方法纳入2012年9月~2013年1月参加＂东营市脑卒中筛查与防治项目＂的高血压患者2 132人,进行问卷调查、体格检查、血生化检查和颈部血管超声检查。按Hcy水平的三分位数将患者分为3组,第1组（≤12.3μmol/L）716人,第2组（12.3~16.5μmol/L）703人,第3组（≥16.5μmol/L）713人。比较3组Hcy水平及其对颈动脉斑块的影响和城乡差异。结果 1第1、2、3组的颈动脉斑块的患病率分别为50.28%、60.03%、65.36%;第2组颈动脉斑块的发生率高于第1组,其差异有统计学意义[OR=1.485,95%CI（1.203,1.833）,P=0.000];第3组的发生率高于第1组,其差异有统计学意义[OR=1.866,95%CI（1.508,2.308）,P=0.000]。2农村高血压人群颈动脉斑块的现患率为62.24%,城市的现患率为52.39%,农村和城市差异有统计学意义[OR=1.500,95%CI（1.259,1.788）,P=0.000]。3以颈动脉有无斑块为因变量,Hcy水平为协变量构建logistic回归模型发现,第2组斑块形成是第1组的1.491倍,第3组斑块形成是第1组的1.752倍。以第1组为参照,对危险因素（性别、年龄、BMI、TG、TC、LDL-C、HDL-C和血糖）进行校正后,第2组斑块形成是第1组的1.388倍,第3组斑块形成是第1组的1.452倍。结论高血压患者Hcy水平的增高与颈动脉斑块的发生率增加具有相关性;农村高血压人群颈动脉斑块的发生率高于城市;对高血压人群来说,高水平的Hcy是颈动脉斑块形成的独立危险因素。

Objective To study the correlation between neck artery vascular sclerosis and homocysteine levels in hypertensive patients. Methods A total of 2 132 patients with hypertension participated in the program of ＂Stroke screening and prevention in Dongying city＂ were included from Sep. 2012 to Jan. 2013. Questionnaire, physical examination, biochemical blood tests and carotid artery ultrasound were conducted in all included patients. According to the level of homocysteine （Hcy）, patients were divided into three groups： 716 patients with Hcy level less than 12.3 mm/L were in Group 1, 703 patients with Hcy level 12.3 to 16.5 mm/L were in Group 2, and 713 patients with Hcy level more than 16.5 mm/L were in Group 3. The influence of Hcy levels on carotid atherosclerosis was analyzed. Results （1） The prevalence rate for carotid plaques in Groups 1, 2, and 3 were 50.28%, 60.03% and 65.36%, respectively. The prevalence rate for carotid plaques in Group 2 was higher than that in Group 1 with a statistical difference （OR=1.485, 95% CI 1,203 to 1.833, P=0.000）. The prevalence rate in Group 3 was also higher than that in Group 1 with a statistical difference （OR=1.866, 95% CI 1.508 to 2.308, P=0.000）. （2） The prevalence rate for carotid plaques was 62.24% in the rural population, and 52.39% in the urban population. The difference between urban and rural populations was statistically significant （OR=I.500, 95% CI 1.259 to 1.788, P=0.000）. （3） Using the presence of carotid plaques as a dependent variable and Hcy level as a covariant, logistic regression analysis found that the plaque formation in Group 2 was 1.491 times than in Group 1 and the plaque formation in Group 3 was 1.752 times than in Group 1. After adjusting the risk factors （gender, age, BMI, TG, TC, LDL-C, HDL-C and blood sugar level）, the results showed that the plaque formation in Group 2 was 1.388 times than in Group 1, and the plaque formation in Group 3 was 1.452 times than in Group 1. Conclusion There is a correlation between the increased incidence of carotid plaque and homocysteine levels in patients with hypertension. The incidence of carotid plaque in the rural population with hypertension is higher than that in the urban population. In the population with hypertension, high homocysteine level is an independent risk factor for the formation of carotid plaques.