高血压患者同型半胱氨酸水平与代谢综合征及心血管病之间关系的研究

The association of homocysteine levels with metabolic syndrome and cardiovascular events in the hypertension

目的：探讨高血压患者同型半胱氨酸（Hcy）水平与代谢综合征（MS）及心血管疾病之间的关系。方法：选取2014年1月至2015年6月,于我院诊断为高血压患者362例。根据有无MS或Hcy水平对患者进行分类,记录所有患者的年龄、性别、腰围、血压、糖尿病、冠心病及脑血管病等临床特征及肌酐清除率、尿蛋白、尿酸、TG及维生素B12等生化指标。利用Logistic分析方法分析高血压患者的Hcy水平与MS及心血管病间的关系。结果：高血压患者Hcy水平的升高与MS、冠心病及脑血管病发病率的增加有关。血浆Hcy水平与患者年龄、腰围、血糖、TG、尿酸、纤维蛋白原水平及稳态模型评估（HOMA）指数直接相关,与肌酐清除率、HDL-C、维生素B12及叶酸水平呈负相关。Logistic回归分析显示,Hcy水平与MS的发生相关（RR：1.01,95%CI：1.00~1.02,P=0.02）且独立于人口统计学及单变量分析中与Hcy相关的变量。Hcy与心血管疾病发生也相关（RR：1.01;95%CI：1.00~1.02;P=0.01）,也独立于其他混杂因素。结论：高血压患者高同型半胱氨酸水平与代谢综合征相关,同时与更高的心血管发病率相关。

Objective： To investigate the association of homocysteine（ Hcy） levels with metabolic syndrome and cardiovascular events in the hypertension. Methods： 362 patients diagnosed as hypertension in our hospital from January 2014 to June 2015 were chosen in this study. According to the presence or absence of metabolic syndrome or Hcy level,patients were classified. Clinical features including age,sex,waist circumference,blood pressure,diabetes and cerebrovascular disease and biochemical variables including creatinine clearance,urinary protein,uric acid,triglyceride and vitamin B12 were recorded. The association of Hcy levels with metabolic syndrome and cardiovascular events in the hypertension were analyzed with the logistic regression methods. Results： Increasing Hcy levels were associated with an increasing prevalence of the metabolic syndrome,coronary heart disease and cardiovascular diseases. Plasma Hcy was directly correlated with age,waist circumference,glucose,triglyceride,uric acid,fibrinogen levels and HOMA index and inversely with creatinine clearance,high-density lipoprotein cholesterol,vitamin B12,and folate levels. Logistic regression analysis showed Hcy levels were associated with the presence of metabolic syndrome（ RR： 1. 01; 95% CI： 1. 00-1. 02;P = 0. 02） independent of demographic variables and other variables that were related with Hcy on univariate regression analysis. Similarly,Hcy levels were associated with the presence of cardiovascular events（ RR： 1. 01;95% CI： 1. 00-1. 02; P = 0. 01） independent of other confounders. Conclusion： Elevated plasma Hcy is associated with the metabolic syndrome in hypertensive patients,and also associated with greater prevalence of cardiovascular events.