H型高血压与急性脑梗死患者颈动脉结构和功能变化相关性分析

Clinical analysis of relationship between carotid artery structure and function changes and H-type hypertension in acute cerebral infarction patients

目的探讨急性脑梗死患者颈动脉结构和功能变化与H型高血压的相关性。方法采用前瞻性队列研究方法,根据颈动脉超声结果将2014年9月至2015年9月于上海市第一人民医院分院神经科住院的247例急性脑梗死患者分为斑块组和对照组,比较两组患者的一般资料及实验室指标。根据同型半胱氨酸(homocysteine,Hcy)水平检测结果和有无高血压病史,将患者分为H型高血压组、非H型高血压组、高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)组和正常对照组,比较H型高血压组与其他三组患者颈动脉结构和功能指标的差异性。以斑块组和对照组分组为因变量,以急性脑梗死患者颈动脉结构和功能变化的可能危险因素为自变量,进行多因素Logistic回归分析;采用交互作用分析相加模型分析高血压和HHcy对急性脑梗死患者颈动脉结构和功能变化的联合作用。结果斑块组与对照组危险因素分析显示:两组患者年龄、高血压病史、吸烟史、Hcy和低密度脂蛋白(LDL)水平比较差异均具有显著性(P<0.05),其他危险因素组间比较差异不明显。H型高血压组患者颈动脉内膜中层厚度[(1.59±0.09)mm]较非H型高血压组[(1.08±0.05)mm]、HHcy组[(0.58±0.09)mm]和正常对照组[(0.47±0.07)mm]明显增加(P<0.05)。H型高血压组患者斑块指数(4.89±1.28)较非H型高血压组(2.81±1.43)、HHcy组(1.20±0.96)和正常对照组(1.12±0.86)明显升高(P<0.05)。H型高血压组患者颈动脉扩张性和顺应性(0.28±0.14,712.10±129.31)较非H型高血压组(0.45±0.12,507.20±122.14)、HHcy组(0.96±0.11,203.11±121.01)和正常对照组(0.87±0.18,197.31±98.17)均明显下降(P<0.05)。多因素Logistic回归分析显示:年龄、高血压病史、LDL水平是急性脑梗死患者颈动脉结构和功能变化的独立危险因素。交互作用分析显示:高血压和HHcy在急性脑梗死患者颈动脉结构和功能变化中发挥协同作用,其效应大于二者之和。结论年龄、高血压病史、LDL水平是急性脑梗死患者颈动脉结构和功能变化的独立危险因素。高血压与HHcy同时存在时,对急性脑梗死患者颈动脉结构和功能损害表现出明显的协同作用,H型高血压较传统高血压更易损害急性脑梗死患者的颈动脉结构和功能。

Objective To investigate the relationship between carotid artery structure and function changes and H-type hypertension in acute cerebral infarction patients. Method Based on prospective cohort study design, according to the results of carotid artery ultrasound, 247 patients with acute cerebral infarction in Branch of Shanghai First People＇s Hospital from September 2014 to September 2015 were divided into plaques group and control group, the general information and laboratory indexes were measured between the two groups. According to the Hcy inspection results and the presence of hypertension, they were divided into H-type hypertension group, pure hypertension group, hyperhomocysteinemia （HHcy） group, and normal control group, analyzed the diferences of carotid artery structure indicators between H-type hypertension group and other three groups. Multi-factor Logistic regression analysis was performed on the risk factors which may cause the change of the carotid atery structure and function between paque group and control group; joint interaction analysis of the additive model was adopted to analyze the koinonia of hypertension and HHcy for acute cerebral infarction patients with carotid artery structure and function changes. Result The risk factors analysis between plaque group and control group showed that： age, hypertension, smoking history between the two groups had significant differences （P 〈 0.05）, the diferences of other risk factors were not obvious. The intima-media thickness of the H-type hypertension group [（1.59±0.09） mm] was much thicker than pure hypertension group [（1.08± 0.05） mm], HHcy group [（0.58±0.09） mm] and normal control group [（0.47±0.07） mm] （P 〈 0.05）. The plaque index of the H-type hypertension group （4.89±1.28） was much larger than pure hypertension group （2.81 ± 1.43）, HHcy group （1.20±0.96） and control group （1.12±0.86） （P 〈 0.05）. The dilatancy and dilatancy of carotid artery of H-type hypertension group （0.28±0.14, 712.10±129.31） was weaker than pure hypertension group （0.45 ±0.12, 507.20±122.14）, HHcy group （0.96±0.11,203.11± 121.01） and control group （0.870±0.18, 197.31±98.17） （P 〈 0.05）. The multi-factor Logistic regression analysis showed that age, history of hypertension, LDL level were the independent risk factors of acute cerebral infarction patients with carotid atherosclerotic plaque formation. The interaction analysis showed that： hypertension and HHcy played a synergistic role in structure and functional changes of patients with acute cerebral infarction, the effect was greater than the sum of both. Conclusion Age, history of hypertension, LDL level are the independent risk factors of the acute cerebral infarction patients with carotid atherosclerotic plaque formation. Hypertension and HHcy play a synergistic role in structure and functional changes of patients with acute cerebral infarction. The structure and ftmction of carotid artery in patients with acute cerebral infarction are more easily damaged by H-type hypertension than traditional hypertension.