一体化护理模式对老年冠心病合并心力衰竭患者的影响

Influence of hyperhomocysteinemia on blood pressure variability and left ventricular remodeling in elderly patients with essential hypertension

目的 观察高同型半胱氨酸（Hcy）血症对老年原发性高血压患者血压变异性及左室重构的影响.方法 选取2014年5月-2015年5月于新疆医科大学附属中医医院住院治疗的61例老年原发性高血压患者,其中男性36例,女性25例,平均年龄（66.5±6.8）岁.根据患者入院时血浆Hcy水平,分为H型高血压组27例及非H型高血压组34例.比较H型高血压组与非H型高血压组的血压变异性指标（24 h、日间及夜间血压变异系数）及左室重构指数（左室舒张末期内径、左室收缩末期内径、左室后壁厚度、室间隔厚度、左室射血分数）.结果 两组患者在平均年龄、性别比例、体质指数、吸烟史、糖尿病、高脂血症比例无差异（P〉0.05）.H型高血压组24 h、日间及夜间血压变异系数明显比非H型高血压组升高（P〈0.05）.H型高血压组中,血浆Hcy水平与24 h收缩压变异系数呈明显正相关（r=0.373,P〈0.05）,且左室肥厚例数明显比非H型高血压增加（25.93% vs. 8.82%,P〈0.05）.H型高血压组的左室舒张末期内径、左室收缩末期内径、左室后壁厚度、室间隔厚度、左室质量指数均高于非H型高血压组（P〈0.05）.H型高血压组中,血浆Hcy与左室质量指数（r=0.325,P〈0.05）、左室后壁厚度（r=0.284,P〈0.05）呈正相关.结论 高Hcy血症与老年原发性高血压患者血压变异性增大、左室重构呈正相关.

Objective To observe the influence of hyperhomocysteinemia on blood pressure variability （BPV）and left ventricular remodeling in elderly patients with essential hypertension. Methods The elderly patients withessential hypertension （n=61, male 36, female 25 and average age=66.5±6.8） were chosen from May 2014 to May2015, and then were divided, according to the level of plasma homocysteine （Hcy）, into H-type group （n=27） andnon-H-type group （n=34）. The indexes of BPV （24 h BP variation coefficient, daytime BP variation coefficient andnighttime BP variation coefficient） and indexes of left ventricular remodeling [left ventricular end-diastolic innerdiameter （LVEDd）, left ventricular end-systolic diameter （LVESd）, left ventricular posterior wall thickness （LVPWT）,interventricular septal thickness （IVST） and left ventricular ejection fraction （LVEF）] were compared between 2 groups.Results There was no difference in average age, sex, body mass index, smoking history and percentages of cases ofdiabetes and hyperlipidemia between 2 groups （P〉0.05）. The indexes of BPV （24 h BP variation coefficient, daytimeBP variation coefficient and nighttime BP variation coefficient） were higher in H-type group than those in non-H-type （P〈0.05）. The level of plasma Hcy was positively correlated to 24 h systolic blood pressure variation coefficient （r=0.373,P〈0.05） in H-type group, and percentage of cases of left ventricular hypertrophy was significantly higher in H-typegroup than that in non-H-type （25.93% vs. 8.82%, P〈0.05）. LVEDd, LVESd, LVPWT, IVST and left ventricularmass index （LVMI） were all higher in H-type group than those in non-H-type （P〈0.05）. The level of plasma Hcywas positively correlated to LVMI （r=0.325, P〈0.05） and LVPWT （r=0.284, P〈0.05） in H-type group. ConclusionHyperhomocysteinemia shows positive correlation to increased BPV and left ventricular remodeling in elderly patientswith essential hypertension.