高血压患者血浆同型半胱氨酸与血压变异的相关性

Correlation between plasma homocysteine and blood pressure variability in hypertensive patients

目的:探讨原发性高血压患者血浆同型半胱氨酸(Hcy)水平与血压变异的相关性。方法:选择原发性高血压患者110例作为研究对象。测量所有患者血生化指标及动态血压水平。将入选患者按血浆Hcy水平分为正常Hcy组(n=56)和高Hcy组(n=54),对两组患者的年龄、性别、血生化、动态血压各参数进行比较。将入选患者按照血压不同昼夜节律分为非杓型组(n=45)、杓型组(n=40)、极度杓型组(n=10)、反杓型组(n=15),对4组患者的年龄、性别、血浆Hcy、血生化进行比较。对患者血浆Hcy与动态血压各参数进行相关性分析。结果:高Hcy组男性比例较正常Hcy组高(P<0.001);高Hcy组患者白昼、夜间、24h平均收缩压及平均舒张压较正常Hcy组高(P<0.05);高Hcy组高密度脂蛋白较正常Hcy组低(P=0.036),高Hcy组血肌酐水平较正常Hcy组高(P=0.001)。反杓型组患者血浆Hcy较其他3组高(P=0.001)。患者血浆Hcy与白昼、夜间、24h平均收缩压及平均舒张压线性相关(P<0.05);血浆Hcy与血压变异、变异系数不存在线性相关。结论:血浆Hcy水平可能与高血压及异常血压昼夜节律有关,在治疗高血压的同时应积极降低血浆Hcy水平。

Objective：To investigate the corrleation between plasma homocysteine（Hcy）level and blood pressure variability in patients with essential hypertension.Methods：110 patients with essential hypertension were selected as the subjects.Blood biochemical indexes and ambulatory blood pressure were measured in all patients.The patients were divided into two groups according to the level of plasma Hcy：normal Hcy group（n=56）and high Hcy group（n=54）.The parameters of age,sex,blood biochemistry and ambulatory blood pressure of the two groups were compared.The patients were divided into 4 groups according to different circadian rhythms：non-dipper group（n=45）,dipper group（n=40）,extreme dipper group（n=10）,and anti-dipper group（n=15）.The age,sex,plasma Hcy and blood biochemistry of the 4 groups were compared.The correlation between Hcy and ambulatory blood pressure parameters was analyzed.Results：The percentage of men was higher in the high Hcy group than that in the normal Hcy group（P 〈0.001）.The mean systolic blood pressure and mean diastolic blood pressure during the day,the night and 24 hin the high Hcy group were higher than those in the normal Hcy group（P〈0.05）.The HDL was lower in the high Hcy group than in the normal Hcy group（P=0.036）.The serum creatinine was higher in the high Hcy group than in the normal Hcy group（P =0.001）.The Hcy concentration was significantly higher in the anti-dipper group than in the other three groups（P=0.001）.Correlation analysis showed that there was a linear correlation between Hcy and daytime,nighttime,24 h mean systolic blood pressure and mean diastolic blood pressure（P〈0.05）,and there was no linear correlation between plasma Hcy and blood pressure variability or coefficient of variation.Conclusions：Plasma Hcy levels may be related to target organ damage caused by hypertension and abnormal circadian rhythm.Hcy may be a mediator for the link between BP variability and target damage,and plasma Hcy levels should be actively lowered in the treatment of hypertension.