高血压合并动脉粥样硬化患者血清CysC、Hcy的表达及临床意义

Expression and clinical significance of serum CysC and Hcy in patients with hypertension complicated with atherosclerosis

目的 探讨血清胱抑素C(CysC)、同型半胱氨酸(Hcy)在高血压合并动脉粥样硬化发生发展进程中的表达及临床意义。方法 选取126例高血压合并动脉粥样硬化患者,高血压1级(高血压1级组)38例、高血压2级(高血压2级组)40例、高血压3级(高血压3级组)48例;另选取同期52例无动脉硬化健康志愿者作为对照组。四组使用彩色多普勒超声测量受试者颈动脉内膜中层厚度(CIMT)值和斑块特点,采用全自动生化检测仪测定受试者血清Hcy和CysC水平。比较四组CIMT、Hcy、CysC、斑块形成情况;比较颈动脉正常与颈动脉硬化1、2、3级患者血清Hcy和CysC水平;分析高血压合并颈动脉粥样硬化影响因素。结果 对照组CIMT为(0.73±0.08)mm、Hcy为(8.03±2.01)μmol/L、CysC为(0.81±0.12)mg/L、斑块形成占比为3.85%;高血压1级组患者CIMT为(1.08±0.07)mm、Hcy为(12.97±2.09)μmol/L、CysC为(1.09±0.16)mg/L、斑块形成占比为18.42%;高血压2级组患者CIMT为(1.21±0.10)mm、Hcy为(14.79±2.14)μmol/L、CysC为(1.32±0.12)mg/L、斑块形成占比为40.00%;高血压3级组患者CIMT为(1.39±0.09)mm、Hcy为(16.87±2.15)μmol/L、CysC为(1.68±0.17)mg/L、斑块形成占比为62.50%。血清Hcy、CysC水平、CIMT和斑块形成患者占比随高血压严重程度加剧呈依次递升趋势,高血压1、2、3级组患者高于对照组,差异均具有统计学意义(P<0.05)。颈动脉正常与颈动脉硬化1、2、3级患者Hcy分别为(13.57±4.15)、(21.39±5.35)、(32.73±11.46)、(38.26±14.57)μmol/L,CysC分别为(1.10±0.26)、(1.60±0.34)、(1.86±0.41)、(2.27±0.81)mg/L。血清Hcy和CysC表达水平随颈动脉硬化程度加剧呈依次递升趋势,颈动脉硬化1、2、3级硬化患者Hcy和CysC均高于颈动脉正常患者, 2、3级硬化患者高于1级, 3级硬化患者高于2级,差异具有统计学意义(P<0.05)。Logistic回归分析显示,血清Hcy、CysC水平和斑块形成均为高血压合并颈动脉粥样硬化的影响因素(P<0.05)。结论 患者血清Hcy和CysC是发生高血压合并动脉粥样硬化的影响因素,可作为预测动脉粥样硬化发生发展的早期指标。

Objective To discuss the expression and clinical significance of serum Cystatin C(CysC)and homocysteine(Hcy)in patients with hypertension complicated with atherosclerosis.Methods 126 patients with hypertension and atherosclerosis were selected,with 38 cases of hypertension grade 1(hypertension grade 1 group),40 cases of hypertension grade 2(hypertension grade 2 group),and 48 cases of hypertension grade 3(hypertension grade 3 group).52 healthy volunteers without atherosclerosis were selected as the control group during the same period.Carotid intima-media thickness(CIMT)and plaque characteristics of the subjects were measured by color Doppler ultrasound;serum Hcy and CysC levels of the subjects were measured by a fully automated biochemical assay.Comparison was made on CIMT,Hcy,CysC,and plaque formation among the four groups,as well as serum Hcy and CysC levels between patients with normal carotid arteries and patients with atherosclerosis grade 1,2,and 3.The influencing factors of hypertension complicated with carotid atherosclerosis were analyzed.Results In the control group,the CIMT was(0.73±0.08)mm,the Hcy was(8.03±2.01)μmol/L,the CysC was(0.81±0.12)mg/L,and the plaque formation accounted for 3.85%;in hypertension grade 1 group,the CIMT was(1.08±0.07)mm,the Hcy was(12.97±2.09)μmol/L,the CysC was(1.09±0.16)mg/L,and the plaque formation accounted for 18.42%;in hypertension grade 2 group,the CIMT was(1.21±0.10)mm,the Hcy was(14.79±2.14)μmol/L,the CysC was(1.32±0.12)mg/L,and the plaque formation accounted for 40.00%;in hypertension grade 3 group,the CIMT was(1.39±0.09)mm,the Hcy was(16.87±2.15)μmol/L,the CysC was(1.68±0.17)mg/L,and the plaque formation accounted for 62.50%.The serum Hcy and CysC levels,CIMT and proportion of patients with plague formation tended to increase sequentially with the increase in the severity of hypertension,and the hypertension grade 1,2 and 3 groups were higher than the control group,and the differences were statistically significant(P<0.01).The Hcy in patients with normal carotid arteries and patients with grades 1,2,and 3 atherosclerosis were(13.57±4.15),(21.39±5.35),(32.73±11.46),and(38.26±14.57)μmol/L,and the CysC were(1.10±0.26),(1.60±0.34),(1.86±0.41),and(2.27±0.81)mg/L.The expression levels of serum Hcy and CysC in patients showed a tendency to increase sequentially with the increase of carotid atherosclerosis,Hcy and CysC in patients with grades 1,2,and 3 carotid arteriosclerosis were higher than those in patients with normal carotid arteries;patients with grades 2 and 3 carotid arteriosclerosis were higher than grade 1 carotid arteriosclerosis patients;carotid atherosclerosis grade 3 patients were higher than grade 2 carotid atherosclerosis patients.and the differences were all statistically significant(P<0.05).Logistic regression analysis showed that serum Hcy,CysC levels and plaque formation were all influencing factors for carotid atherosclerosis in combination with hypertension(P<0.05).Conclusion Serum Hcy and CysC in patients are influencing factors for hypertension complicated with atherosclerosis,and can be used as early indicators to predict the occurrence and development of atherosclerosis.