不同水平同型半胱氨酸对糖尿病合并高血压患者颈动脉斑块积分的影响

Effects of different levels of homocysteine on carotid artery plaque score in patients with diabetes mellitus complicated with hypertension

目的观察不同水平的同型半胱氨酸(HCY)对2型糖尿病合并高血压患者颈动脉粥样硬化的影响。方法通过检测糖化血红蛋白、同型半胱氨酸、血脂、肝肾功能、颈动脉彩超检查,全部糖尿病合并高血压研究对象按同型半胱氨酸水平分成三组,分为组1(HCY<10μmol/L)、组2(10μmol/L≤HCY≤15μmol/L)、组3(HCY>15μmol/L),计算颈动脉斑块等级积分,进行统计学分析。结果统计结果显示随着同型半胱氨酸水平的升高,颈动脉积分逐渐升高,组1、组2分别和组3比较,颈动脉斑块积分升高有统计学意义(P<0.05),采用Spearman相关分析法分析HCY水平与颈动脉斑块积分呈正相关。三组间的低密度脂蛋白、胆固醇、收缩压、舒张压、脉压、糖化血红蛋白均无明显差异。结论 HCY独立于血糖水平、血压等因素下参与糖尿病合并高血压患者动脉粥样硬化进程,并对颈动脉粥样硬化起促进作用,在临床工作中应对同型半胱氨酸水平升高的患者予以高度重视,积极进行危险分层管理,控制同型半胱氨酸水平,警惕其心脑血管不良事件的发生。

Objective To observe the effect of different levels of homocysteine（HCY） on carotid atherosclerosis in patients with type 2 diabetes mellitus complicated with hypertension. Methods All patients with diabetes mellitus com bined with hypertension were divided into three groups including group 1（HCY10 μmol/m L）, group 2（10 μmol/L≤HCY≤15 μmol/L） and group 3（HCY 15 μmol/L） by detecting glycosylated hemoglobin, homocysteine, blood lipid, liver and kidney function and carotid artery ultrasonography. The carotid plaque score was calculated and analyzed statistically. Results The results showed that with the increase of homocysteine level, the carotid artery plaque score increased gradually, and there was significant difference in the increase of carotid artery plaque score among group 1,group 2 and group 3（P〈0.05）. And Spearman correlation analysis showed that HCY level was positively correlated with carotid artery plaque score. There was no significant difference in low-density lipoprotein, cholesterol, systolic blood pressure, diastolic blood pressure, pulse pressure and glycosylated hemoglobin between the three groups. Conclusion HCY, independent of blood glucose levels, blood pressure and other factor, is involved in the process of atherosclerosis in patients with diabetes mellitus and hypertentsion, and promotes the carotid atherosclerosis. In clinical work serious attention should be paid to patients with increased levels of homocysteine. The active stratified risk management and the control of homocysteine levels are applied in the patients, and their cardiovascular and cerebrovascular events should be alerted to.