老年H型高血压患者亚临床炎症变化与颈动脉损害特点的关系及其临床意义

Relationship between subclinical inflammatory changes and characteristics of carotid artery injury in elderly patients with type H hypertension and its clinical significance

目的探讨老年H型高血压患者亚临床炎症变化与颈动脉损害特点的关系及其临床意义。方法 96例高血压患者,按照同型半胱氨酸水平与年龄不同分为观察组(老年H型高血压患者)、对照1组(中年H型高血压患者)、对照2组(老年非H型高血压患者),各32例。对三组患者均进行颈动脉超声检查及生化指标检测,观察比较三组患者舒张压、收缩压及同型半胱氨酸水平,颈动脉内中膜厚度(IMT)、双侧颈总动脉平均僵硬度参数(CCA-mβ)、斑块总积分(Crouse积分)、动脉扩张性系数(DC),白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平。结果三组舒张压及收缩压比较,差异无统计学意义(P>0.05);观察组同型半胱氨酸水平(20.08±2.32)μmol/L高于对照1组的(15.25±1.32)μmol/L和对照2组的(6.52±0.45)μmol/L,差异有统计学意义(P<0.05)。观察组IMT、CCA-mβ、Crouse积分均高于对照1组和对照2组, DC低于对照1组和对照2组,差异有统计学意义(P<0.05)。观察组IL-6、IL-8、TNF-α、CysC、hs-CRP水平均高于对照1组、对照2组,差异有统计学意义(P<0.05)。结论老年H型高血压患者的颈动脉损害程度与临床炎症变化具有密切关系,尤其是同型半胱氨酸,其是一种可控危险因子,早期可通过有效干预措施抑制同型半胱氨酸水平,对减轻颈动脉损害程度及降低并发症发生率具有积极作用。

Objective To discuss the relationship between subclinical inflammatory changes and characteristics of carotid artery injury in elderly patients with type H hypertension and its clinical significance.Methods A total of 96 hypertension patients were divided by homocysteine level and age into observation group(elderly patients with H-type hypertension),control group 1(middle-aged patients with H-type hypertension) and control group 2(elderly patients with non-H-type hypertension), with 32 cases in each group. All three groups received carotid ultrasound examination and biochemical indicators detection. Observation and comparison were made on diastolic blood pressure,systolic blood pressure and homocysteine levels,carotid intima-media thickness(IMT), bilateral common carotid artery mean stiffness parameters(CCA-m β), plaque score(Crouse integral),arterial dilatation coefficient(DC),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),cy statin C(CysC), and hypersensitive C-reactive protein(hs-CRP) levels in three groups.Results Three groups had no statistically significant difference in diastolic blood pressure and systolic blood pressure(P>0.05). The observation group had higher homocysteine as(20.08±2.32)μmol/L than(15.25± 1.32)μmol/L in control group1 and(6.52±0.45)μmol/L in control group 2. Their difference was statistically significant(P<0.05). The observation group had higher IMT, CCA-m β and Crouse integral than control group 1 and control group 2, and lower DC than control group 1 and control group. Their difference was statistically significant(P<0.05). The observation group had higher IL-6, IL-8, TNF-α, CysC and hs-CRP than control group 1 and control group2, and their difference was statistically significant(P<0.05). Conclusion The degree of carotid artery damage in elderly patients with H-type hypertension is closely related to clinical inflammation changes, especially homocysteine, which is a controllable risk factor. Early intervention can inhibit the level of homocysteine, and it plays a positive role in reducing the degree of carotid artery damage and the incidence of complications.