血浆同型半胱氨酸与动脉粥样硬化早期进展的相关分析

Association of plasma homocysteine with the early progression of atherosclerosis

目的 探讨动脉粥样硬化早期进展的危险因素,高同型半胱氨酸血症(HHcy)是否为动脉粥样硬化早期进展的独立危险因素,降低同型半胱氨酸(Hcy)是否能延缓动脉粥样硬化的早期进展。方法 选取陕西省汉中市柳林镇年龄≥40岁村民,分别于2017年5月、2020年6月行结构化问诊、颈动脉超声检查和血液化验。通过超声检测颈动脉内膜中层厚度(CIMT)、颈动脉斑块和颈动脉狭窄率反应动脉硬化程度。结果 共有500例纳入最终分析,其中基线无CIMT增厚451例,基线无颈动脉斑块429例,基线无颈动脉狭窄454例。经过3年的随访,500例中有176例CIMT增厚,占总数的35.2%,经多因素分析,高龄、吸烟和高低密度脂蛋白胆固醇(LDL-C)为CIMT增厚的独立危险因素;252例新发斑块,占比为50.4%,经多因素分析,高龄、高血压、高LDL-C为斑块形成的独立危险因素;231例新发颈部动脉狭窄,占比46.2%,经多因素分析,高龄、高LDL-C、甘油三酯升高是颈部动脉狭窄形成的独立危险因素。初查HHcy(≥15μmol/L)患者有364例,3年后有119例Hcy较前下降,245例Hcy较前未下降。经调整性别、既往卒中、吸烟、基线LDL-C、基线Hcy、3年后Hcy后行多因素分析,HHcy和降低Hcy均未显示出与颈动脉粥样硬化的相关性。结论 我国陕西汉中市农村地区40岁及以上村民动脉粥样硬化的危险因素主要有高龄、高LDL-C、吸烟、高血压等;未发现HHcy与颈动脉粥样硬化有明显相关性,未发现降低Hcy能延缓或逆转颈动脉粥样硬化进程。

Objective To investigate the risk factors for the early progression of atherosclerosis,whether hyperhomocysteinemia(HHcy)is an independent risk factor for the early progression of atherosclerosis,and whether the reduction in homocysteine(Hcy)can delay the early progression of atherosclerosis.Methods The villagers,aged≥40 years,from Liulin Town of Hanzhong City,Shaanxi Province,China were selected for structured inquiry,carotid ultrasound examination,and blood test in May 2017 and June 2020.Ultrasound examination was performed to measure carotid intima-media thickness(CIMT),carotid plaque,and carotid stenosis rate to reflect the degree of arteriosclerosis.Results A total of 500 individuals were included in the final analysis,among whom 451 had no CIMT thickening at baseline,429 had no carotid plaque at baseline,and 454 had no carotid stenosis at baseline.After 3 years of follow-up,among the 500 individuals,176(35.2%)had CIMT thickening,and the multivariate analysis showed that old age,smoking,and a high level of low-density lipoprotein cholesterol(LDL-C)were independent risk factors for CIMT thickening;252(50.4%)had new-onset plaques,and the multivariate analysis showed that old age,hypertension,and high LDL-C were independent risk factors for plaque formation;231(46.2%)had new-onset carotid stenosis,and the multivariate analysis showed that old age,high LDL-C,and elevated triglyceride were independent risk factors for carotid stenosis.There were 364 patients with HHcy(≥15μmol/L)in the initial examination,and after 3 years,119 had a reduction in Hcy,while 245 had no reduction in Hcy.After adjustment for sex,previous stroke,smoking,baseline LDL-C,baseline Hcy,and Hcy after 3 years,the multivariate analysis showed that neither HHcy nor the reduction in Hcy was associated with carotid atherosclerosis.Conclusion Old age,high LDL-C,smoking,and hypertension are the main risk factors for atherosclerosis in villagers aged≥40 years in rural areas of Hanzhong City in Shaanxi Province.There is no significant association between HHcy and carotid atherosclerosis,and the reduction in Hcy cannot delay or reverse the process of carotid atherosclerosis.