老年高血压合并冠心病患者同型半胱氨酸、胱抑素C与颈部血管超声指标的关系

Relationship among homocysteine, cystatin C and cervical vascular ultrasound indicators in elderly patients with hypertension combined with coronary heart disease

目的探讨老年高血压合并冠心病患者血清同型半胱氨酸(Hcy)、胱抑素(Cys)C及颈部血管超声指标的变化和关系。方法选取82例老年高血压合并冠心病患者作为研究对象,根据心功能分级标准分为Ⅰ级27例、Ⅱ级25例、Ⅲ级19例和Ⅳ级11例。酶联免疫吸附试验(ELISA)检测血清Hcy水平,免疫投射比浊法检测血清CysC水平,并通过颈部彩超检查测量颈动脉内膜中层厚度(IMT)及颈动脉Crouse斑块积分。结果不同心功能分组间患者血清Hcy、CysC水平及IMT、Crouse斑块积分等颈部超声指标的差异均有统计学意义(P<0.05),并且心功能越差,上述指标水平则越高(P<0.05);不同IMT组间患者血清Hcy和CysC水平的差异均有统计学意义(P<0.05),并且IMT越严重,上述指标水平则越高(P<0.05);研究对象血清Hcy、CysC水平均与IMT值、Crouse斑块积分等颈部超声指标呈明显正相关,差异均有统计学意义(P<0.05)。结论老年高血压合并冠心病患者血清Hcy、CysC水平及颈部血管超声指标存在明显异常,并且Hcy、CysC与颈部血管超声指标存在相关性,共同参与疾病的发生发展过程。

Objective To investigate the changes and relationships of serum homocysteine(Hcy), cystatin(Cys) C and cervical vascular ultrasound indicators in elderly patients with hypertension combined with coronary heart disease(CHD). Methods 82 elderly patients with hypertension combined with CHD were selected as research objects and divided into grade I(27 cases), grade Ⅱ(25 cases), grade Ⅲ(19 cases) and grade Ⅳ(11 cases) groups according to the cardiac function. The serum levels of Hcy and CysC were respectively measured by ELISA and immunoprojection nephelometry, and the carotid intima-media thickness(IMT) and Crouse plaque score were detected by carotid ultrasonography. Results There were statistically significant differences in the indicators of Hcy, CysC, carotid IMT and Crouse plaque score among different cardiac function groups(P<0.05), and the levels of the above indicators were significantly higher as the cardiac function was worse(P<0.05). There were statistically significant differences in the serum levels of Hcy and CysC among different IMT groups(P<0.05), and the levels of the above indicators were significantly higher as the carotid IMT was worse(P<0.05). The serum levels of Hcy and CysC were significantly positively correlated with the indicators of carotid IMT and Crouse plaque score respectively(P<0.05). Conclusions There are obvious abnormalities in serum Hcy, CysC and cervical vascular ultrasound indicators in elderly patients with hypertension combined with CHD. The levels of Hcy and CysC are correlated with cervical vascular ultrasound indicators and participate in the occurrence and development of disease.