H型高血压患者动态血压变异性特点及在叶酸辅助干预治疗下动脉硬化疗效分析研究

The characteristics of dynamic blood pressure variability in patients with H-type hypertension and analysis about curative effect of arteriosclerosis under folic acid assisted intervention

目的观察H型高血压患者的动态血压昼夜节律,探讨叶酸干预治疗对H型高血压患者血浆同型半胱氨酸(Hcy)代谢变化及脉搏波传导速度(PWV)的影响。方法连续收集2015年01月—2017年12月期间,就诊于新疆兵团医院心内科住院原发性高血压患者,根据Hcy水平分为H型高血压组(简称"H组")与非H型高血压组(简称"非H组")两组,对H组用随机数字表法将患者随机分为2亚组,在降压基础上加用叶酸治疗为治疗组,另一组为对照组。结果纳入研究的381例高血压患者全为汉族,年龄(56.84±11.91)岁,男:女=1.12:1。H组200例(治疗组100例,非治疗组100例),非H组181例。动态血压监测显示,H组较非H组患者的勺型、反杓形血压的发生率及夜间平均收缩压方面存在差异,且差异有统计学意义(χ^(2)=5.369,P=0.027;χ^(2)=16.378,P=0.000;Z=1.987,P=0.048)。H组PWV水平较非H组明显升高,差异有统计学意义(Z=4.487,P=0.000)。两组给予治疗时间12个月,随访时间8~12个月,平均10个月,H组较非H组ΔHcy水平差异有统计学意义(Z=-10.716,P=0.000),ΔPWV水平差异无统计学意义(Z=1.392,P=0.194)。治疗组较对照组Hcy(Z=-10.809,P=0.000)、ΔHcy(Z=-19.657,P=0.000)、PWV(Z=-2.086,P=0.038)、ΔPWV(Z=-5.599,P=0.000)水平差异有统计学意义。结论Hcy会影响高血压昼夜节律变化,H型高血压较非H型高血压患者容易导致动脉硬化,叶酸干预治疗可以明显使H型高血压患者的血浆Hcy水平降低,减缓动脉硬化进程。

Objective To observe the circadian rhythm of dynamic blood pressure in patients with H-type hypertension and explore the effect of folic acid intervention on plasma homocysteine metabolism and pulse wave conduction velocity in patients with H-type hypertension.Methods From January 2015 to December 2017,patients who were hospitalized with essential hypertension at the department of cardiology of our hospital were divided into two groups,H hypertension group(referred to as"H group")and non-H hypertension group(referred to as"non-H group")according to Hcy level.In group H,all patients were randomly divided into two sub-groups by random number table method.The treatment group was treated with folic acid on the basis of decompression,and the other group was chosen as controlled group.Results Totally 432 patients with H-type hypertension were enrolled in this study with the age of61.7±13.6 years old and the ratio between men and women is 1.3.All of them were Han Chinese.There were 200 cases in H group,including 100 cases in treatment group,100 cases in non-treatment group,and 181 cases in non-H group.Dynamic blood pressure monitoring results showed that there were differences in the incidence and average night systolic pressure between the patients in H group and non-H group,and the difference was statistically significant(χ^(2)=5.369,P=0.027;χ^(2)=16.378,P=0.000;Z=1.987,P=0.048).The level of PWV in H group was significantly higher than that in non-H group,and the difference was statistically significant(Z=4.487,P=0.000).The two groups were treated for 12 months.The follow-up time was 8~12 months,and average follow-up time was 10 months.The level ofΔHcy in the H group was statistically significantly different from that in the non-H group(Z=-10.716,P=0.000).But there was no significant difference in the level ofΔPWV between two groups(Z=1.392,P=0.194).Compared with the control group,the levels of Hcy(Z=-10.809,P=0.000),ΔHcy(Z=-19.657,P=0.000),PWV(Z=-2.086,P=0.038),andΔPWV in the H group(Z=-5.599,P=0.000)were statistically significantly different.Conclusion Hcy can affect the circadian rhythm of hypertension.H-type hypertension is more likely to lead to arteriosclerosis than non H type hypertension.Folic acid intervention can significantly reduce the level of Hcy in patients with H-type hypertension and slow down the process of arteriosclerosis.