摘要
目的分析西安市雁塔区脑卒中高危人群血浆同型半胱氨酸(Hcy)水平与血压之间的相关关系。方法以社区脑卒中高危人群为基础进行横断面研究,研究对象来源于2012年8月—2012年12月参加西安市雁塔区"卫计委脑卒中筛查与防治工程"的脑卒中高危人群。采集高血压病史,测量随机坐位血压,空腹采集肘静脉血,测定血浆Hcy水平。血浆Hcy>15.0μmol/L为高同型半胱氨酸血症(HHcy),其中Hcy(15~30)μmol/L为血浆Hcy轻度升高,Hcy≥31μmol/L为血浆Hcy中重度增高。应用单因素分析、多因素Logistic回归模型、多因素线性回归模型分析血浆Hcy与血压的相关性。结果符合入组标准者共1 392人,其中233人血样发生溶血、18人因排除标准被排除在外,实际纳入分析人数为1 141人。男性461人(40.4%),年龄40岁~90岁(64.31岁±9.81岁),高血压病625人,非高血压病516人,规律或间断服用降压药物者513人,未服用降压药物者(含非高血压病者以及未服药的高血压病者)628人。收缩压(SBP)为(138.34±20.46)mmHg,舒张压(DBP)为(83.76±11.53)mmHg、平均动脉压(MABP)为(101.95±12.97)mmHg呈正态分布。血浆Hcy水平呈偏态分布16(12,22)μmol/L,HHcy者609人(53.4%),血浆Hcy轻度升高者478人(41.9%),血浆Hcy中重度升高者131人(11.5%)。在所有研究对象中,血浆Hcy轻度升高组、血浆Hcy中重度升高组高血压病患病率高于正常血浆Hcy组(正常血浆Hcy组vs血浆Hcy轻度升高组vs血浆Hcy中重度升高组为50.0%vs 58.4%vs 61.1%,P_(三组间)=0.009,P_(轻度升高组vs正常组)=0.008,P_(中重度升高组vs正常组)=0.023)。多因素Logistic回归分析提示,HHcy与高血压病正相关(OR=1.411,95%CI 1.076~1.851,P=0.013)。单因素分析显示,在无降压药物使用人群中,3组间SBP存在显著差异(正常血浆Hcy组vs血浆Hcy轻度升高组vs血浆Hcy中重度升高组:1 2 7.9 2mmHg vs 1 3 5.1 5mmHg vs 1 3 7.8 6mmHg,P_(三组间)<0.0 0 1,P_(轻度升高组vs正常组)<0.0 0 1,P_(中重度升高组vs正常组)<0.001),Spearmen秩相关分析提示,SBP与血浆Hcy水平正相关(r=0.226,P<0.001),多因素线性回归提示HHcy与SBP显著正相关(β=5.564,P<0.001),将HHyc换成3分类资料(血浆Hcy正常组、血浆Hcy轻度升高组、血浆Hcy中重度升高组)后,血浆Hcy升高,血浆Hcy轻度升高组(β=5.096,P=0.001),血浆Hcy中重度升高组(β=7.686,P=0.003),与SBP仍显著正相关。血浆Hcy与DBP、MABP的关系同SBP类似。在正在服用降压药物亚组中分析,测血压与血浆Hcy水平的关系,单因素与多因素分析均未发现两者之间存在显著的相关性。结论西安市雁塔区脑卒中高危人群HHcy与高血压病之间显著正相关,HHcy者高血压病患病风险较高。在未服用降压药物人群中,血浆Hcy水平与现测血压显著正相关,在正在服用降压药物的人群中,受降压药物影响,两者之间未见显著相关性。
Objective To investigate the relationship between the plasma homocysteine(Hcy)and blood pressure in the population at high risk of stroke form Yanta Districtas,Xi'an,China.Methods This research was designed as a cross-sectional study based on community population at high risk of stroke,who were from Screening and Prevention Program of Stoke in Yanta Districtas,Xi'an,which was organized by National Health and Family Planning Commission of the People's Republic of China from August to December in 2012.The information about hypertension history,blood pressure in a seated position and other covariates were collected during in-person interview.The plasma Hcy was determined with fasting venous blood sample by the biochemical laboratory of the First Affiliated Hospital of Xi'an Jiaotong University.Hyperhomocysteinmia(HHcy)was defined as Hcy15 μmol/L,Hcy in the range of 16-30 μmol/L was mild hyperhomocysteinemia,and ≥31 μmol/L was moderate-severe hyperhomocysteinemia.Univariate analysis,multivariate logistic regression and multivariate linear regression were performed to analyses the relationship between plasma Hcy and blood pressure.Results A total of 1 392 individuals were included,and 253 subjects were excluded because of specimen hemolysis(n =233)and other reasons(n =18),the left 1 141 subjects(men:n =461,40.4% )were analyzed.The participants aged 40-49 years(64.31 years ±9.81 years).Six hundreds and twenty-five subjects were diagnosed as hypertension.513 subjects took antihypertensive drugs regularly or irregularly,and the rest 628 subjects didn't take antihypertensive drugs.In the total population,systolic blood pressure(SBP,138.34 mmHg ±20.46 mmHg),diastolic blood pressure(DBP,83.76 mmHg ±11.53 mmHg)and mean arterial blood pressure(MABP,101.95 mmHg ±12.97 mmHg)were normally distributed,and plasma Hcy showed a skewed distribution[median(25% percentile,75% percentile),16(12,22) μmol/L],and 609 participants(53.4% )were diagnosed as HHcy.Four hundreds and seventy-eight of them(41.9% )were with mild HHcy and131 subjects(11.5% )were with moderate-severe HHcy.The prevalence of hypertension in the subjects with mild HHcy and moderate-severe HHcy are significantly higher compared with the subjects with normal Hcy(normal Hcy vs mild HHcy vs moderate-severe HHcy,50.0% vs 58.4% vs 61.1% ,Pamong the three groups=0.009,P(mild HHcy vs normal Hcy)=0.008,P(moderate-severe HHcy vs normal Hcy)=0.023)in the univariate analysis;and HHcy was positively correlated with hypertension after the covariates were corrected using logistic model in the multivariate analysis.In the subgroup without antihypertensive drugs,univariate t-test indicated that there were significant differences in the SBP among the three groups(normal Hcy vs mild HHcy vs moderate-severe HHcy,127.92 mmHg vs 135.15 mmHg vs 137.86 mmHg,P among the three groups0.001,P(mild HHcy vs normal Hcy)0.001,P(moderate-severe HHcy vs normal Hcy)0.001).Spearman rank correlation analysis showed that the plasma Hcy were positively associated with SBP(r=0.226,P〈0.001).Multivariate linear regression analysis revealed that HHcy(β=5.564,P〈0.001)was positively related with SBP after correcting the covariates.Subsequently,the plasma Hcy were transformed into three categories,normal Hcy,mild HHcy and moderate-severe HHcy.Multivariate linear regression analysis showed that both mild HHcy[β=5.096,P =0.001]and moderate-severe HHcy[β=7.686,P =0.003]were positively related with SBP.Results similar to those for SBP were obtained for DBP and MABP as well.No significant correlation between Hcy and blood pressure(SBP,DBP or MABP)was found in the subgroup with antihypertensive drugs.Conclusion The plasma Hcy was positively related with hypertension in the population at high risk for stroke form Yanta Districtas,Xi'an,China.In the subgroup without antihypertensive drugs,the plasma Hcy was positively associated with SBP,DBP and MABP,however,in the subgroup with antihypertensive drugs,such a relationship was disappeared.
出处
《中西医结合心脑血管病杂志》
2017年第24期3186-3193,共8页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
科技部"重大新药创新"重大专项项目(No.2012ZX09
303-005-002)